MEDICARE: MIDDLETOWN HEALTHCARE MANAGEMENT INC

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	4712	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000098058	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326036047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLETOWN HEALTHCARE MANAGEMENT INC

Provider Business Mailing Address
First Line	:	131 S 10TH ST
Second Line	:
City	:	MIDDLETOWN
State	:	IN
Zip	:	47356-9772
Country	:	US
Telephone Number	:	765-354-2223
Fax Number	:	765-354-9066

Provider Business Practice Location Address
First Line	:	131 S 10TH ST
Second Line	:
City	:	MIDDLETOWN
State	:	IN
Zip	:	47356-9772
Country	:	US
Telephone Number	:	765-354-2223
Fax Number	:	765-354-9066

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SANDRA ELLEN SPAUGH
Credential	:	ADMIN/RN
Telephone Number	:	765-354-2223

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	12/28/2009

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