Basic Information
| Provider Information | |||||||||
| NPI: | 1114016987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HANCOCK REGIONAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 129 | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461400129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174686221 | ||||||||
| FaxNumber: | 3174686267 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEMORIAL SQ STE 100 | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461402819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174623255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 08/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF FINANCE & BUSINESS SERV | ||||||||
| AuthorizedOfficialTelephone: | 3174854577 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1114016987 | 01 | IN | NPI NUMBER FOR HANCOCK REGIONAL HOSPITAL - | OTHER | 000000493483 | 01 | IN | ANTHEM PIN # | OTHER | 200941580A | 05 | IN | MEDICAID | 200841490 | 05 | IN | MEDICAID | 1467485003 | 01 | IN | NPI NUMBER FOR HANCOCK REGIONAL HOSPITAL | OTHER |