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General NPI Number Information
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NPI Number | 1831679620
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Entity Type | Organization
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Legal Business Name | PULASKI MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 414 LANE ST
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City | NORTH JUDSON
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State | IN
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Zip | 46366-1226
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Country | US
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Telephone | 574-896-4325
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 279
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City | WINAMAC
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State | IN
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Zip | 46996-0279
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Country | US
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Telephone | 574-946-2100
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | GREGG MALOTT
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Credential |
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Telephone | 574-946-2103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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