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General NPI Number Information
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NPI Number | 1487016549
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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 | 03/27/2016
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Last Update Date | 03/27/2016
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Provider Practice Location Address
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Address Line | 214 CRENSHAW DR
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City | SAINT PAUL
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State | IN
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Zip | 47272-9435
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Country | US
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Telephone | 812-593-5903
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Fax |
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Provider Business Mailing Address
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Address Line | 214 CRENSHAW DR
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City | SAINT PAUL
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State | IN
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Zip | 47272-9435
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Country | US
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Telephone | 812-593-5903
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. JASON CADWALLADER
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Credential | MD
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Telephone | 317-346-7929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 71006159A
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License Number State | IN
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