Provider Demographics
NPI:1518905447
Name:PUTNAM COUNTY HOSPITAL
Entity Type:Organization
Organization Name:PUTNAM COUNTY HOSPITAL
Other - Org Name:THE WATERS OF GREENCASTLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-655-2620
Mailing Address - Street 1:1601 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-2268
Mailing Address - Country:US
Mailing Address - Phone:765-653-2602
Mailing Address - Fax:765-653-2387
Practice Address - Street 1:1601 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2268
Practice Address - Country:US
Practice Address - Phone:765-653-2602
Practice Address - Fax:765-653-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000109-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000381424OtherANTHEM BCBS
IN000000476416OtherANTHEM ST
IN000000476415OtherANTHEM OT
IN100266290CMedicaid
IN5586590001OtherDMERC REGION B SUPPLIER#
IN000000476414OtherANTHEM PT
IN000000476416OtherANTHEM ST
IN5586590001OtherDMERC REGION B SUPPLIER#