Provider Demographics
NPI:1114982253
Name:JASPER COUNTY HOSPITAL
Entity Type:Organization
Organization Name:JASPER COUNTY HOSPITAL
Other - Org Name:BROOK HEALTH CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-866-5141
Mailing Address - Street 1:1104 E GRACE ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-3211
Mailing Address - Country:US
Mailing Address - Phone:219-866-5141
Mailing Address - Fax:219-866-3234
Practice Address - Street 1:420 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOK
Practice Address - State:IN
Practice Address - Zip Code:47922-8715
Practice Address - Country:US
Practice Address - Phone:219-275-2521
Practice Address - Fax:219-275-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000809A363LF0000X
IL71000862A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100187080AMedicaid
IN100187080AMedicaid
IN158502Medicare PIN