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General NPI Number Information
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NPI Number | 1497764450
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Entity Type | Organization
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Legal Business Name | WHITLEY MEMORIAL HOSPITAL, INC.
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1250 E STATE ROAD 205
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City | COLUMBIA CITY
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State | IN
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Zip | 46725
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Country | US
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Telephone | 260-248-9302
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Fax | 260-248-9107
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Provider Business Mailing Address
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Address Line | PO BOX 5600
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City | FORT WAYNE
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State | IN
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Zip | 46895-5600
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Country | US
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Telephone | 260-373-7008
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Fax | 260-373-7059
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Authorized Official
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Title or Position | ACFO
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Name | STANTON RISSER
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Credential |
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Telephone | 260-266-9380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 0091
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License Number State | IN
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