Provider Demographics
NPI:1275506024
Name:JAY COUNTY HOSPITAL
Entity Type:Organization
Organization Name:JAY COUNTY HOSPITAL
Other - Org Name:LIFEBRIDGE
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT INFORMATION SERVICES COORDI
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-726-1812
Mailing Address - Street 1:500 W VOTAW ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-1322
Mailing Address - Country:US
Mailing Address - Phone:260-726-7131
Mailing Address - Fax:260-726-1976
Practice Address - Street 1:500 W VOTAW ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1322
Practice Address - Country:US
Practice Address - Phone:260-726-7131
Practice Address - Fax:260-726-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN005029273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100269610BMedicaid
IN15M320Medicare Oscar/Certification