Basic Information
Provider Information | |||||||||
NPI: | 1023340965 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | DAVIESS COUNTY HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | DCH HEALTH PAVILION | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 760 | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | IN | ||||||||
PostalCode: | 475010760 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8122547310 | ||||||||
FaxNumber: | 8122578602 | ||||||||
Practice Location | |||||||||
Address1: | 1805 S STATE ROAD 57 | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | IN | ||||||||
PostalCode: | 475014326 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8122547845 | ||||||||
FaxNumber: | 8122545989 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/03/2010 | ||||||||
LastUpdateDate: | 01/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SHOWALTER | ||||||||
AuthorizedOfficialFirstName: | ANTHONY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT OF THE BOARD OF DIRECTORS | ||||||||
AuthorizedOfficialTelephone: | 8122542760 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.