Provider Demographics
NPI:1417029315
Name:JASPER COUNTY HOSPITAL
Entity Type:Organization
Organization Name:JASPER COUNTY HOSPITAL
Other - Org Name:JASPER COUNTY HOSPITAL ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCIAL SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:219-866-5141
Mailing Address - Street 1:1104 E GRACE ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-3211
Mailing Address - Country:US
Mailing Address - Phone:219-866-5141
Mailing Address - Fax:219-866-3234
Practice Address - Street 1:1104 E GRACE ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-3211
Practice Address - Country:US
Practice Address - Phone:219-866-5141
Practice Address - Fax:219-866-3234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASPER COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-005072-2282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000297276OtherBLUE CROSS
IN100269680AMedicaid
IN000000297276OtherBLUE CROSS
IN100269680AMedicaid