Provider Demographics
NPI:1205839826
Name:JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Other - Org Name:BERTHA D GARTEN KETCHAM MEMORIAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WITTMER
Authorized Official - Suffix:
Authorized Official - Credentials:HFA
Authorized Official - Phone:812-636-4920
Mailing Address - Street 1:601 E RACE ST
Mailing Address - Street 2:
Mailing Address - City:ODON
Mailing Address - State:IN
Mailing Address - Zip Code:47562-1425
Mailing Address - Country:US
Mailing Address - Phone:812-636-4920
Mailing Address - Fax:812-636-4763
Practice Address - Street 1:601 E RACE ST
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562-1425
Practice Address - Country:US
Practice Address - Phone:812-636-4920
Practice Address - Fax:812-636-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050003001314000000X
IN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100287340AMedicaid
IN100287340AMedicaid