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General NPI Number Information
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NPI Number | 1255352399
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Entity Type | Organization
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Legal Business Name | JOHNSON MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 787 N DETROIT ST
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City | LAGRANGE
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State | IN
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Zip | 46761-1111
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Country | US
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Telephone | 574-466-2172
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Fax | 574-463-2180
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Provider Business Mailing Address
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Address Line | 1125 W JEFFERSON ST
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City | FRANKLIN
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State | IN
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Zip | 46131-2140
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Country | US
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Telephone | 317-736-3396
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Fax | 317-736-2692
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DAVID DUNKLE
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Credential | MD
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Telephone | 317-736-3396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 06-000049-1
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License Number State | IN
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