Provider Demographics
NPI:1093712887
Name:DECATUR COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DECATUR COUNTY MEMORIAL HOSPITAL
Other - Org Name:WESTPORT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-663-1172
Mailing Address - Street 1:308 E MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47283-9369
Mailing Address - Country:US
Mailing Address - Phone:812-222-3627
Mailing Address - Fax:812-663-1155
Practice Address - Street 1:308 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:IN
Practice Address - Zip Code:47283-9369
Practice Address - Country:US
Practice Address - Phone:812-222-3627
Practice Address - Fax:812-663-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200220600BMedicaid