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General NPI Number Information
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NPI Number | 1508825720
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Entity Type | Organization
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Legal Business Name | FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC.
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Dates
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Enumeration Date | 03/18/2006
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 1941 VIRGINIA AVE
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City | CONNERSVILLE
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State | IN
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Zip | 47331-2833
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Country | US
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Telephone | 765-825-5131
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Fax | 765-827-7733
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Provider Business Mailing Address
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Address Line | 1941 VIRGINIA AVENUE
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City | CONNERSVILLE
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State | IN
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Zip | 47331
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Country | US
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Telephone | 765-825-5131
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Fax | 765-827-7733
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Authorized Official
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Title or Position | CEO
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Name | MR. RANDY WHITE
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Credential |
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Telephone | 765-825-5131
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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 | 050050591
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License Number State | IN
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