Basic Information
| Provider Information | |||||||||
| NPI: | 1740655299 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DECATUR COUNTY MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DECATUR COUNTY PRIMARY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 N LINCOLN ST | ||||||||
| Address2: | STE A | ||||||||
| City: | GREENSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472401348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126620588 | ||||||||
| FaxNumber: | 8126635932 | ||||||||
| Practice Location | |||||||||
| Address1: | 718 N LINCOLN ST | ||||||||
| Address2: | STE A | ||||||||
| City: | GREENSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472401348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126620588 | ||||||||
| FaxNumber: | 8126635932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2015 | ||||||||
| LastUpdateDate: | 12/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | HENSLEY | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF AMBULATORY SRVC. | ||||||||
| AuthorizedOfficialTelephone: | 8122220793 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.