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General NPI Number Information
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NPI Number | 1598192957
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Entity Type | Organization
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Legal Business Name | WITHAM MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 10/01/2013
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 1108 KINGWOOD DRIVE
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City | AVON
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State | IN
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Zip | 46123-5500
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Country | US
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Telephone | 317-204-1100
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Fax | 317-271-7054
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Provider Business Mailing Address
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Address Line | 8455 KEYSTONE CROSSING
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-4353
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Country | US
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Telephone | 317-818-1240
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Fax | 317-552-2086
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Authorized Official
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Title or Position | CEO, PRESIDENT
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Name | KELLY BRAVERMAN
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Credential |
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Telephone | 765-485-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 13-012901-1
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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