Provider Demographics
NPI:1558443077
Name:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC
Entity Type:Organization
Organization Name:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC
Other - Org Name:MARTIN COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-996-0507
Mailing Address - Street 1:800 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2514
Mailing Address - Country:US
Mailing Address - Phone:812-996-0299
Mailing Address - Fax:812-996-8497
Practice Address - Street 1:229 HIGH ST
Practice Address - Street 2:
Practice Address - City:SHOALS
Practice Address - State:IN
Practice Address - Zip Code:47581-5501
Practice Address - Country:US
Practice Address - Phone:812-247-2733
Practice Address - Fax:812-247-2373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE COMPANY OF MARY HOSPTIAL OF INDIANA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200298610AMedicaid
INCB3118OtherRAILROAD MEDICARE
INCB3118OtherRAILROAD MEDICARE
INTB5210Medicare PIN
IN153860Medicare Oscar/Certification