MEDICARE: DAVIESS COUNTY 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	15-000250-1	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	:	1235177981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIESS COUNTY HOSPITAL

Provider Business Mailing Address
First Line	:	7519 WINCHESTER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-2242
Country	:	US
Telephone Number	:	260-747-7435
Fax Number	:	260-747-9282

Provider Business Practice Location Address
First Line	:	7519 WINCHESTER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-2242
Country	:	US
Telephone Number	:	260-747-7435
Fax Number	:	260-747-9282

Authorized Official
Title or Position	:	BOARD MEMBER
Name	:	MR. DERON STEINER
Credential	:
Telephone Number	:	812-254-2760

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	03/08/2021

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Directions to “DAVIESS COUNTY HOSPITAL ” Practice Location

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