=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952300477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DECATUR COUNTY MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2005
-----------------------------------------------------
Last Update Date | 04/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 N. LINCOLN ST
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47240-1398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-663-4331
-----------------------------------------------------
Fax | 812-663-1316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 N. LINCOLN ST
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47240-1398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-663-4331
-----------------------------------------------------
Fax | 812-663-1316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF FINANCE
-----------------------------------------------------
Name | MICHAEL RUCKEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 812-663-4331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 07-004714-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------