Basic Information
| Provider Information | |||||||||
| NPI: | 1942373154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HENRY COUNTY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 485 | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473620485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655211516 | ||||||||
| FaxNumber: | 7655993131 | ||||||||
| Practice Location | |||||||||
| Address1: | 152 WITTENBRAKER AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473625035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655210901 | ||||||||
| FaxNumber: | 7655219891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | RING | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 7655211515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HENRY COUNTY MEMORIAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 50003788A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000000292051 | 01 | IN | ANTHEM | OTHER | 100134640A | 05 | IN | MEDICAID |