Basic Information
Provider Information
NPI: 1669475950
EntityType: 2
ReplacementNPI:  
OrganizationName: HENDRICKS COUNTY HOSPITAL
LastName:  
FirstName:  
MiddleName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 1000 E MAIN ST
Address2:  
City: DANVILLE
State: IN
PostalCode: 461221948
CountryCode: US
TelephoneNumber: 3177454451
FaxNumber: 3177458400
Practice Location
Address1: 1000 E MAIN ST
Address2:  
City: DANVILLE
State: IN
PostalCode: 461221948
CountryCode: US
TelephoneNumber: 3177454451
FaxNumber: 3177458400
Other Information
ProviderEnumerationDate: 05/31/2005
LastUpdateDate: 02/15/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KOMENDA
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName: J
AuthorizedOfficialTitleorPosition: CHIEF FINANCIAL OFFICER
AuthorizedOfficialTelephone: 3177453511
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X010129INY HospitalsGeneral Acute Care Hospital 

ID Information
IDTypeStateIssuerDescription
00000009787001INANTHEM BLUE CROSSOTHER
100270050A05IN MEDICAID


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