Provider Demographics
NPI:1467511790
Name:DAVIESS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:DAVIESS COUNTY HOSPITAL
Other - Org Name:MONTGOMERY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-254-8620
Mailing Address - Street 1:427 N FIRST ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IN
Mailing Address - Zip Code:47758
Mailing Address - Country:US
Mailing Address - Phone:812-486-2842
Mailing Address - Fax:812-486-2784
Practice Address - Street 1:427 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IN
Practice Address - Zip Code:47758
Practice Address - Country:US
Practice Address - Phone:812-486-2842
Practice Address - Fax:812-486-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057351A261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270240DMedicaid
IN100270240DMedicaid