=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497856272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HENDRICKS COUNTY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 01/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 HOSPITAL LN STE 302
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46122-1998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-272-7510
-----------------------------------------------------
Fax | 317-272-7514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 HOSPITAL LN STE 302
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46122-1998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-272-7510
-----------------------------------------------------
Fax | 317-272-7514
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING
-----------------------------------------------------
Name | SHELLEY MOBLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-837-5570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------