Basic Information
| Provider Information | |||||||||
| NPI: | 1841258035 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PERRY COUNTY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8885 SR 237 | ||||||||
| Address2: | |||||||||
| City: | TELL CITY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475862750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125477011 | ||||||||
| FaxNumber: | 8125470174 | ||||||||
| Practice Location | |||||||||
| Address1: | 8885 SR 237 | ||||||||
| Address2: | |||||||||
| City: | TELL CITY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125477011 | ||||||||
| FaxNumber: | 8125470174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VPFS | ||||||||
| AuthorizedOfficialTelephone: | 8125470146 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 15Z322 | IN | Y | Hospital Units | Medicare Defined Swing Bed Unit |
No ID Information.