Provider Demographics
NPI:1598058414
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:CULLEN MEDICAL PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:W
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-482-2345
Mailing Address - Street 1:2005 STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-8558
Mailing Address - Country:US
Mailing Address - Phone:812-254-4650
Mailing Address - Fax:812-254-4081
Practice Address - Street 1:2005 STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-8558
Practice Address - Country:US
Practice Address - Phone:812-254-4650
Practice Address - Fax:812-254-4081
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-25
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M100048128Medicare PIN