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1124062419

NPI Code Detail

MEDICARE: WASHINGTON COUNTY MEMORIAL HOSPITAL

MEDICARE: WASHINGTON COUNTY 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	207L00000X	Anesthesiology Physician
2	207P00000X	Emergency Medicine Physician
3	207Q00000X	Family Medicine Physician
4	207V00000X	Obstetrics & Gynecology Physician
5	207X00000X	Orthopaedic Surgery Physician
6	2085R0202X	Diagnostic Radiology Physician
7	208VP0000X	Pain Medicine Physician
8	275N00000X	Medicare Defined Swing Bed Hospital Unit
9	282NC0060X	Critical Access Hospital	0050871	IN
10	3416L0300X	Land Ambulance
11	363L00000X	Nurse Practitioner
12	282NC0060X	Critical Access Hospital	07-005087-1	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	940950	OTHER	IN	MEDICARE PART B

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000054337	OTHER	IN	BLUE CROSS PROVIDER #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	030969400	OTHER	IN	FEDERAL BLACK LUNG
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124062419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	911 N. SHELBY ST.
Second Line	:
City	:	SALEM
State	:	IN
Zip	:	47167-2304
Country	:	US
Telephone Number	:	812-883-5881
Fax Number	:	812-883-8557

Provider Business Practice Location Address
First Line	:	911 N. SHELBY ST.
Second Line	:
City	:	SALEM
State	:	IN
Zip	:	47167-2304
Country	:	US
Telephone Number	:	812-883-5881
Fax Number	:	812-883-8557

Authorized Official
Title or Position	:	CEO
Name	:	JOE ROCHE
Credential	:
Telephone Number	:	81288635881

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/22/2009

Similar Medicare Providers

1518959998 — DR. PATRICIA REED TATE M.D.
Practice Location Address:

911 N SHELBY ST
SALEM, IN
47167-2304

Practice Phone: 812-883-5881
Practice Fax:

1346235553 — NOEL COURTNEY PUTMAN CRNA
Practice Location Address:

911 N SHELBY ST
SALEM, IN
47167-2304

Practice Phone: 812-883-5881
Practice Fax:

1659543536 — BROCK EMERGENCY PHYSICIANS
Practice Location Address:

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SALEM, IN
47167-2304

Practice Phone: 812-883-5881
Practice Fax:

1477729234 — DR. ABDELRAHMAN M ABDALLA MD
Practice Location Address:

911 N SHELBY ST
SALEM, IN
47167-2304

Practice Phone: 812-896-0108
Practice Fax: 812-883-8556

1821223439 — CRITICAL ACCESS HEALTH SERVICES CORP.
Practice Location Address:

911 N SHELBY ST
SALEM, IN
47167-2304

Practice Phone: 812-883-8550
Practice Fax:

1497987259 — WASHINGTON COUNTY EMERGENCY MEDICAL SERVICES, INC.
Practice Location Address:

911 N SHELBY ST
SALEM, IN
47167-2304

Practice Phone: 812-883-8550
Practice Fax: 812-883-8563

Directions to “WASHINGTON COUNTY MEMORIAL HOSPITAL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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