Provider Demographics
NPI:1154326098
Name:PERRY COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:PERRY COUNTY MEMORIAL HOSPITAL
Other - Org Name:PERRY COUNTY MEMORIAL HOSPITAL HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-547-0146
Mailing Address - Street 1:8885 SR 237
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-2750
Mailing Address - Country:US
Mailing Address - Phone:812-547-7011
Mailing Address - Fax:812-547-0174
Practice Address - Street 1:115 US HIGHWAY 66 E
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586
Practice Address - Country:US
Practice Address - Phone:812-547-7011
Practice Address - Fax:812-547-0229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERRY COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-16
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN005344251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100264720Medicaid
IN157177Medicare Oscar/Certification