Provider Demographics
NPI:1053301259
Name:JOHNSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JOHNSON MEMORIAL HOSPITAL
Other - Org Name:COMPASS PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-736-3300
Mailing Address - Street 1:690 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2591
Mailing Address - Country:US
Mailing Address - Phone:317-736-6141
Mailing Address - Fax:317-346-1434
Practice Address - Street 1:800 FREEMASON PARKWAY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2553
Practice Address - Country:US
Practice Address - Phone:317-736-6141
Practice Address - Fax:317-346-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-001133-1310400000X, 313M00000X, 314000000X
IN15-001133-1314000000X
IN200520750347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200520750Medicaid
IN200090430Medicaid
IN200090430Medicaid