Provider Demographics
NPI:1518904978
Name:MAJOR HOSPITAL
Entity Type:Organization
Organization Name:MAJOR HOSPITAL
Other - Org Name:THE WATERS OF CLIFTY FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-398-5252
Mailing Address - Street 1:950 CROSS AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2002
Mailing Address - Country:US
Mailing Address - Phone:812-273-4640
Mailing Address - Fax:812-273-2925
Practice Address - Street 1:950 CROSS AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2002
Practice Address - Country:US
Practice Address - Phone:812-273-4640
Practice Address - Fax:812-273-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000116-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000384632OtherANTHEM BCBS OT OUTPATIENT
IN100266330CMedicaid
IN000000384634OtherANTHEM BCBS PT OUTPATIENT
IN000000380292OtherANTHEM BCBS
IN000000384633OtherANTHEM BCBS ST OUTPATIENT
IN5584770001Medicare NSC
IN000000384633OtherANTHEM BCBS ST OUTPATIENT