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	060004771	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0783610001	OTHER	IN	DMEAC
2	000000112922	OTHER	IN	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982710943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULASKI MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	7476 W LANE RD.
Second Line	:
City	:	MCCORDSVILLE
State	:	IN
Zip	:	46055-9506
Country	:	US
Telephone Number	:	317-335-2159
Fax Number	:	317-335-3325

Provider Business Practice Location Address
First Line	:	7476 W LANE RD.
Second Line	:
City	:	MCCORDSVILLE
State	:	IN
Zip	:	46055-9506
Country	:	US
Telephone Number	:	317-335-2159
Fax Number	:	317-335-3325

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	GREGG A MALOTT
Credential	:
Telephone Number	:	574-946-2103

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	05/11/2026

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