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NPI Code Detail

MEDICARE: PUTNAM COUNTY HOSPITAL

MEDICARE: PUTNAM 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
1314000000XSkilled Nursing Facility05-000096-1IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000476412OTHERINATNEHM OT
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000381423OTHERINANTHEM BCBS
4000000476411OTHERINANTHEM PT
5000000476413OTHERINANTHEM ST

General Provider Information

NPI Number : 1720026180
Entity Type Code : Organization
Provider Name (Legal Business Name) : PUTNAM COUNTY HOSPITAL
Provider Business Mailing Address
First Line : 2055 HERITAGE DR
Second Line :
City : MARTINSVILLE
State : IN
Zip : 46151-3158
Country : US
Telephone Number : 765-342-3305
Fax Number : 765-342-9575
Provider Business Practice Location Address
First Line : 2055 HERITAGE DR
Second Line :
City : MARTINSVILLE
State : IN
Zip : 46151-3158
Country : US
Telephone Number : 765-342-3305
Fax Number : 765-342-9575
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MR. DENNIS WEATHERFORD
Credential :
Telephone Number : 765-655-2620
Provider Enumeration Date : 06/04/2006
Last Update Date : 10/27/2014

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1417286642 — MRS. TRACI ARNOLD PTA
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Directions to “PUTNAM COUNTY HOSPITAL ” Practice Location

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