Provider Demographics
NPI:1518074541
Name:HARRISON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:HARRISON COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-738-4251
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0038
Mailing Address - Country:US
Mailing Address - Phone:812-738-4251
Mailing Address - Fax:812-738-7833
Practice Address - Street 1:1141 HOSPITAL DRIVE NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2164
Practice Address - Country:US
Practice Address - Phone:812-738-7865
Practice Address - Fax:812-738-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000054339�OtherANTHEM IN�
KY000000182520�OtherANTHEM KY. LAB�
IN100128260A�Medicaid
IN100268260A�Medicaid
KY01340306�Medicaid
IN100268250A�Medicaid
KY1065774�Medicaid
IN200172560A�Medicaid
KY1065774�Medicaid
IN100268250A�Medicaid
IN151331?Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER?
KY000000182520�OtherANTHEM KY. LAB�