Provider Demographics
NPI:1659497477
Name:STATE OF INDIANA, AUDITOR OF STATE
Entity Type:Organization
Organization Name:STATE OF INDIANA, AUDITOR OF STATE
Other - Org Name:MADISON STATE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDANT AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-265-2611
Mailing Address - Street 1:711 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2143
Mailing Address - Country:US
Mailing Address - Phone:812-265-2611
Mailing Address - Fax:812-265-7227
Practice Address - Street 1:711 GREEN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2143
Practice Address - Country:US
Practice Address - Phone:812-265-2611
Practice Address - Fax:812-265-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
941750OtherMEDICARE B
INPROFESSIONAL COMPOtherGROUP