Provider Demographics
NPI:1033115993
Name:JAY COUNTY HOSPITAL
Entity Type:Organization
Organization Name:JAY COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-726-7131
Mailing Address - Street 1:500 W VOTAW ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-1322
Mailing Address - Country:US
Mailing Address - Phone:260-726-7131
Mailing Address - Fax:260-726-1975
Practice Address - Street 1:500 W VOTAW ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1322
Practice Address - Country:US
Practice Address - Phone:260-726-7131
Practice Address - Fax:260-726-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4103460Medicaid
MI4660888Medicaid
PA0015519050002Medicaid
PA0015519050001Medicaid
KY01341494Medicaid
OH150031Medicaid
TN0150031Medicaid
CA3696733Medicaid
AZ936669Medicaid
TX0719551Medicaid
IL=========001Medicaid
PA0015519050002Medicaid
IN15Z320Medicare Oscar/Certification
KY01341494Medicaid