Provider Demographics
NPI:1346451465
Name:THE LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC..
Entity Type:Organization
Organization Name:THE LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC..
Other - Org Name:JASPER PEDIATRICS OF MEMORIAL HOSPITAL AND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:W
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-996-0503
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-0150
Mailing Address - Country:US
Mailing Address - Phone:812-996-7918
Mailing Address - Fax:812-996-1644
Practice Address - Street 1:721 W 13TH ST
Practice Address - Street 2:SUITE 321
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1855
Practice Address - Country:US
Practice Address - Phone:812-996-7918
Practice Address - Fax:812-996-1644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-24
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038423A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200048850PMedicaid