Provider Demographics
NPI:1619154820
Name:DAVIESS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:DAVIESS COUNTY HOSPITAL
Other - Org Name:DAVIESS COUNTY HOSPITAL PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-254-2760
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:1314 E WALNUT ST
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0032
Mailing Address - Country:US
Mailing Address - Phone:812-254-2760
Mailing Address - Fax:812-254-8636
Practice Address - Street 1:1314 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2860
Practice Address - Country:US
Practice Address - Phone:812-254-2760
Practice Address - Fax:812-254-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010012282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200042020AMedicaid
IN200152680AMedicaid
IN000000098250OtherANTHEM
IN100270240AMedicaid
IN100270240Medicaid
IN200042020AMedicaid
INCA5604Medicare PIN
INCB2060Medicare PIN
IN000000098250OtherANTHEM