MEDICARE: PULASKI MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	4876	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023013455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULASKI MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	203 W FRANCISCAN DR
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-4802
Country	:	US
Telephone Number	:	219-661-5100
Fax Number	:	219-661-5102

Provider Business Practice Location Address
First Line	:	203 FRANCISCAN DR
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-4802
Country	:	US
Telephone Number	:	219-661-5100
Fax Number	:	219-661-5102

Authorized Official
Title or Position	:	CFO
Name	:	MR. GREGG A MALOTT
Credential	:
Telephone Number	:	574-946-2100

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/02/2021

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