Basic Information
| Provider Information | |||||||||
| NPI: | 1598944381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DECATUR COUNTY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 N. LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472401398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126634331 | ||||||||
| FaxNumber: | 8126631299 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 N MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472401487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126637277 | ||||||||
| FaxNumber: | 8126627607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2007 | ||||||||
| LastUpdateDate: | 01/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | MCKINNEY | ||||||||
| AuthorizedOfficialFirstName: | REX | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8126634331 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DECATUR COUNTY MEMORIAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | IN | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 100268720B | 05 | IN | MEDICAID |