Basic Information
| Provider Information | |||||||||
| NPI: | 1467601757 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAY COUNTY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W VOTAW ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473711322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607267131 | ||||||||
| FaxNumber: | 2607261975 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 W VOTAW ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473711322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607267131 | ||||||||
| FaxNumber: | 2607261975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2008 | ||||||||
| LastUpdateDate: | 05/02/2017 | ||||||||
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| AuthorizedOfficialLastName: | MICHAEL | ||||||||
| AuthorizedOfficialFirstName: | DON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2607261818 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 207P00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100269620 | 05 | IN | MEDICAID |