Basic Information
| Provider Information | |||||||||
| NPI: | 1477933398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHNSON MEMORIAL HOSPITAL HEALTH AFFILIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1155 W JEFFERSON ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461312732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173463883 | ||||||||
| FaxNumber: | 3173463141 | ||||||||
| Practice Location | |||||||||
| Address1: | 1155 W JEFFERSON ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461312732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173463883 | ||||||||
| FaxNumber: | 3173463141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2015 | ||||||||
| LastUpdateDate: | 06/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | HEDDEN | ||||||||
| AuthorizedOfficialFirstName: | LIZ | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3177363396 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JOHNSON MEMORIAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1001836A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.