Provider Demographics
NPI:1487016549
Name:JOHNSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JOHNSON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CADWALLADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-346-7929
Mailing Address - Street 1:214 CRENSHAW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:IN
Mailing Address - Zip Code:47272-9435
Mailing Address - Country:US
Mailing Address - Phone:812-593-5903
Mailing Address - Fax:
Practice Address - Street 1:214 CRENSHAW DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:IN
Practice Address - Zip Code:47272-9435
Practice Address - Country:US
Practice Address - Phone:812-593-5903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-27
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006159A282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital