Basic Information
Provider Information | |||||||||
NPI: | 1083959472 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MARGARET MARY COMMUNITY HOSPITAL, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MARGARET MARY PHYSICIAN PARTNERS | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 236 | ||||||||
Address2: |   | ||||||||
City: | BATESVILLE | ||||||||
State: | IN | ||||||||
PostalCode: | 470060236 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8129335441 | ||||||||
FaxNumber: | 8129335446 | ||||||||
Practice Location | |||||||||
Address1: | 112 N BUCKEYE ST | ||||||||
Address2: |   | ||||||||
City: | OSGOOD | ||||||||
State: | IN | ||||||||
PostalCode: | 470371134 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8126893424 | ||||||||
FaxNumber: | 8126891157 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/11/2012 | ||||||||
LastUpdateDate: | 01/03/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DAEGER | ||||||||
AuthorizedOfficialFirstName: | BRIAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 8129335135 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/03/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X |   | IN | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.