Provider Demographics
NPI:1386683753
Name:MAJOR HOSPITAL
Entity Type:Organization
Organization Name:MAJOR HOSPITAL
Other - Org Name:THE WATERS OF RISING SUN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-398-5252
Mailing Address - Street 1:405 RIO VISTA LN
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:IN
Mailing Address - Zip Code:47040-9497
Mailing Address - Country:US
Mailing Address - Phone:812-438-2219
Mailing Address - Fax:812-438-1268
Practice Address - Street 1:405 RIO VISTA LN
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:IN
Practice Address - Zip Code:47040-9497
Practice Address - Country:US
Practice Address - Phone:812-438-2219
Practice Address - Fax:812-438-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000405-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000385261OtherANTHEM PT
IN000000385265OtherANTHEM OT
IN100273800CMedicaid
IN5584960001OtherDMERC REGION B SUPPLIER#
IN000000385264OtherANTHEM ST
IN000000385261OtherANTHEM BCBS PT OUTPATIENT
IN000000385264OtherANTHEM BCBS ST OUTPATIENT
IN000000385265OtherANTHEM BCBS OT OUTPATIENT
IN000000383034OtherANTHEM BCBS
IN5584960001OtherDMERC REGION B SUPPLIER#
IN000000385265OtherANTHEM BCBS OT OUTPATIENT