Provider Demographics
NPI:1619337839
Name:HANCOCK REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:HANCOCK REGIONAL HOSPITAL
Other - Org Name:SOUTHPOINTE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-462-5544
Mailing Address - Street 1:4904 WAR ADMIRAL DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9737
Mailing Address - Country:US
Mailing Address - Phone:317-885-3333
Mailing Address - Fax:317-883-3221
Practice Address - Street 1:4904 WAR ADMIRAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9737
Practice Address - Country:US
Practice Address - Phone:317-885-3333
Practice Address - Fax:317-883-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201256070AMedicaid
155823Medicare Oscar/Certification