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General NPI Number Information
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NPI Number | 1659497477
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Entity Type | Organization
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Legal Business Name | STATE OF INDIANA, AUDITOR OF STATE
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 711 GREEN RD
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City | MADISON
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State | IN
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Zip | 47250-2143
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Country | US
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Telephone | 812-265-2611
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Fax | 812-265-7227
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Provider Business Mailing Address
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Address Line | 711 GREEN RD
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City | MADISON
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State | IN
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Zip | 47250-2143
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Country | US
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Telephone | 812-265-2611
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Fax | 812-265-7227
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Authorized Official
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Title or Position | SUPERINTENDANT AND MEDICAL DIRECTOR
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Name | DR. PEGGY S STEPHENS
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Credential | MD
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Telephone | 812-265-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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