MEDICARE: PULASKI 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	314000000X	Skilled Nursing Facility	05-000522-1	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
2	000000204329	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1932196177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULASKI MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	616 E 13TH ST
Second Line	:
City	:	WINAMAC
State	:	IN
Zip	:	46996-1117
Country	:	US
Telephone Number	:	419-247-2880
Fax Number	:	419-247-2872

Provider Business Practice Location Address
First Line	:	1010 W WASHINGTON CENTER RD
Second Line	:
City	:	FT WAYNE
State	:	IN
Zip	:	46825-4155
Country	:	US
Telephone Number	:	260-489-2552
Fax Number	:	260-487-9912

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS DEVELOPMENT
Name	:	MR. GREGG MALOTT
Credential	:
Telephone Number	:	57494624100

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	02/01/2016

Similar Medicare Providers

1114905882 — HAMILTONS HEALTH AID SERVICES, INC.
Practice Location Address:

142 E COLLINS RD
FT WAYNE, IN
46825-5302

Practice Phone: 260-471-5011
Practice Fax: 260-471-5109

1013977354 — MR. CRAIG A DYER ATC
Practice Location Address:

5050 N CLINTON ST
FT WAYNE, IN
46825-5822

Practice Phone: 260-484-8551
Practice Fax:

1689632804 — TANYA LAURETTE GREEN MSW
Practice Location Address:

310 E DUPONT RD
FT WAYNE, IN
46825-2048

Practice Phone: 260-490-8110
Practice Fax: 260-490-7707

1962560433 — DR. STEVEN RICHARD WERT DDS
Practice Location Address:

1910 ST JOE CENTER ROAD , UNIT #21
FT WAYNE, IN
46825-5000

Practice Phone: 260-483-4588
Practice Fax: 260-471-8427

1124245949 — MR. ANDREAS LOHMAR PT
Practice Location Address:

5310 MERCHANDISE DRIVE
FT. WAYNE, IN
46825

Practice Phone: 260-484-9491
Practice Fax: 260-484-9451

1285839480 — CENTER FOR BRIEF THERAPY PC
Practice Location Address:

423 AIRPORT N. OFFICE PARK
FT. WAYNE, IN
46825-6704

Practice Phone: 260-969-5583
Practice Fax: 260-969-5584

Directions to “PULASKI 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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.