Basic Information
| Provider Information | |||||||||
| NPI: | 1679948319 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KNOX HOSPITAL COMPANY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTHWEST HEALTH- STARKE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 E CULVER RD | ||||||||
| Address2: | |||||||||
| City: | KNOX | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465342216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5747726231 | ||||||||
| FaxNumber: | 5747725948 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 E CULVER RD | ||||||||
| Address2: | |||||||||
| City: | KNOX | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465342216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5747726231 | ||||||||
| FaxNumber: | 5747725948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2015 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LALOR | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/DELEGATED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6292153953 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | Y | Hospitals | General Acute Care Hospital | Rural |
No ID Information.