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1154321099

NPI Code Detail

MEDICARE: JOHNSON MEMORIAL HOSPITAL

MEDICARE: JOHNSON 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	208M00000X	Hospitalist Physician	005001	IN
2	207RP1001X	Pulmonary Disease Physician	005001	IN
3	207R00000X	Internal Medicine Physician	005001	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
2	000000264062	OTHER	IN	ANTHEM PROVIDER NUMBER

General Provider Information

NPI Number	:	1154321099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 800
Second Line	:
City	:	FRANKLIN
State	:	IN
Zip	:	46131-0800
Country	:	US
Telephone Number	:	317-738-7878
Fax Number	:	317-738-7872

Provider Business Practice Location Address
First Line	:	1155 W JEFFERSON ST
Second Line	:	STE 202
City	:	FRANKLIN
State	:	IN
Zip	:	46131-2732
Country	:	US
Telephone Number	:	317-738-7878
Fax Number	:	317-738-7872

Authorized Official
Title or Position	:	DIRECTOR,REVENUE CYCLE
Name	:	LARREL I DAILEY
Credential	:
Telephone Number	:	317-736-3588

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	12/14/2016

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1477933398 — JOHNSON MEMORIAL HOSPITAL HEALTH AFFILIATES
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Directions to “JOHNSON 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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