PERRY COUNTY MEMORIAL HOSPITAL

Provider Demographics

• NPI: 1629621396
• Name: PERRY COUNTY MEMORIAL HOSPITAL
• Entity Type: Organization
• Organization Name: PERRY COUNTY MEMORIAL HOSPITAL
• Other - Org Name: PCMH PROVIDER CLINICS
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: JARED
• Authorized Official - Last Name: STIMPSON
• Authorized Official - Phone: 812-547-0170
• Mailing Address - Street 1: 8885 STATE ROAD 237
• Mailing Address - City: TELL CITY
• Mailing Address - State: IN
• Mailing Address - Zip Code: 47586-8567
• Mailing Address - Country: US
• Mailing Address - Phone: 812-547-7011
• Practice Address - Street 1: 8885 STATE ROAD 237
• Practice Address - City: TELL CITY
• Practice Address - State: IN
• Practice Address - Zip Code: 47586-8567
• Practice Address - Country: US
• Practice Address - Phone: 812-547-0135
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2019-07-22
• Last Update Date: 2024-01-23

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208D00000X	Allopathic & Osteopathic Physicians	General Practice		Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RP1001X	Allopathic & Osteopathic Physicians	Internal Medicine	Pulmonary Disease	Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty
No	213E00000X	Podiatric Medicine & Surgery Service Providers	Podiatrist		Group - Multi-Specialty
No	213ES0103X	Podiatric Medicine & Surgery Service Providers	Podiatrist	Foot & Ankle Surgery	Group - Multi-Specialty
No	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty	Group - Multi-Specialty
No	261QR1300X	Ambulatory Health Care Facilities	Clinic/Center	Rural Health	Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Multi-Specialty
No	363LP2300X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Primary Care	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	300032719	Medicaid
IN	300033542	Medicaid
IN	300034119	Medicaid
KY	7100653040	Medicaid
IN	300035249	Medicaid
KY	7100315860	Medicaid
KY	78904927	Medicaid
KY	65938490	Medicaid
IN	201366090	Medicaid
IN	100323070A	Medicaid
IN	100353910	Medicaid
IN	201001030	Medicaid
IN	200530330	Medicaid
IN	1609918374	Medicaid
IN	200368690	Medicaid
IN	200502720A	Medicaid
IN	201019640	Medicaid
IN	100029720	Medicaid
IN	100225000	Medicaid
IN	200184730	Medicaid