=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598944381
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DECATUR COUNTY MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2007
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 955 N MICHIGAN AVE
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47240-1487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-663-7277
-----------------------------------------------------
Fax | 812-662-7607
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 N. LINCOLN ST
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47240-1398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-663-4331
-----------------------------------------------------
Fax | 812-663-1299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | REX MCKINNEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 812-663-4331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------