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General NPI Number Information
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NPI Number | 1629066790
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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 | 10/12/2005
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 2907 E 136TH ST
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City | CARMEL
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State | IN
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Zip | 46033-9402
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Country | US
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Telephone | 317-846-0265
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Fax | 317-846-3944
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Provider Business Mailing Address
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Address Line | 6401 S US HIGHWAY 41
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City | TERRE HAUTE
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State | IN
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Zip | 47802-4749
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Country | US
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Telephone | 812-298-3002
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Fax | 812-298-3044
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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 | 04-000545-1
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License Number State | IN
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