Provider Demographics
NPI:1376604975
Name:ST JOSEPH'S HOSPITAL OF HUNTINGBURG IN
Entity Type:Organization
Organization Name:ST JOSEPH'S HOSPITAL OF HUNTINGBURG IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:812-683-6107
Mailing Address - Street 1:1900 MEDICAL ARTS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9521
Mailing Address - Country:US
Mailing Address - Phone:812-683-2121
Mailing Address - Fax:812-683-6485
Practice Address - Street 1:1900 MEDICAL ARTS DR
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9521
Practice Address - Country:US
Practice Address - Phone:812-683-2121
Practice Address - Fax:812-683-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1062410OtherPASSPORT
IN01340793OtherUNISYS
IN000000074879OtherANTHEM
INN285027OtherHARMONY
INN285027OtherHARMONY
IN=========0001OtherCHAMPUS
IN15Z321Medicare Oscar/Certification