Provider Demographics
NPI:1477933398
Name:JOHNSON MEMORIAL HOSPITAL HEALTH AFFILIATES
Entity Type:Organization
Organization Name:JOHNSON MEMORIAL HOSPITAL HEALTH AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-736-3396
Mailing Address - Street 1:1155 W JEFFERSON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2732
Mailing Address - Country:US
Mailing Address - Phone:317-346-3883
Mailing Address - Fax:317-346-3141
Practice Address - Street 1:1155 W JEFFERSON ST STE 202
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2732
Practice Address - Country:US
Practice Address - Phone:317-346-3883
Practice Address - Fax:317-346-3141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1001836A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty