Basic Information
| Provider Information | |||||||||
| NPI: | 1316320799 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEPAUW HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8244 E US HIGHWAY 36 | ||||||||
| Address2: | STE. 1100 | ||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461239575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172727500 | ||||||||
| FaxNumber: | 3172727515 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 S LOCUST ST | ||||||||
| Address2: | HOGATE HALL, STE. 100 | ||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461352052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656584555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2015 | ||||||||
| LastUpdateDate: | 07/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | SMALLWOOD | ||||||||
| AuthorizedOfficialFirstName: | MARIJANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3172723688 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HENDRICKS COMMUNITY HOSPITAL | ||||||||
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| AuthorizedOfficialCredential: | RN, MSN, NE-BC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Corporate Health |
No ID Information.