Basic Information
| Provider Information | |||||||||
| NPI: | 1942233598 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HANCOCK REGIONAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KNIGHTSTOWN HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461401270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174625544 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 437 N MCCULLUM ST | ||||||||
| Address2: | |||||||||
| City: | KNIGHTSTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461481138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653455572 | ||||||||
| FaxNumber: | 3174686148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 08/26/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3174684400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 200156500A | 05 | IN | MEDICAID |