Provider Demographics
NPI:1003237173
Name:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA INC
Entity Type:Organization
Organization Name:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA INC
Other - Org Name:WORKWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:W
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-996-2345
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-996-3550
Mailing Address - Fax:812-996-3565
Practice Address - Street 1:695 W 2ND ST
Practice Address - Street 2:SUITE A1
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3240
Practice Address - Country:US
Practice Address - Phone:812-996-3550
Practice Address - Fax:812-996-3565
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-17
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty