Provider Demographics
NPI:1376746818
Name:WELLSTONE REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:WELLSTONE REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-258-1016
Mailing Address - Street 1:2700 VISSING PARK RD.
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-5989
Mailing Address - Country:US
Mailing Address - Phone:812-284-8000
Mailing Address - Fax:812-258-1094
Practice Address - Street 1:2700 VISSING PARK RD.
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5989
Practice Address - Country:US
Practice Address - Phone:812-284-8000
Practice Address - Fax:812-258-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)