Provider Demographics
NPI:1679577357
Name:JOHNSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JOHNSON MEMORIAL HOSPITAL
Other - Org Name:JMH IMMEDIATE/OCCUPATION HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-346-6176
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-0314
Mailing Address - Country:US
Mailing Address - Phone:317-346-6176
Mailing Address - Fax:317-736-3548
Practice Address - Street 1:2085 ACORN RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-7301
Practice Address - Country:US
Practice Address - Phone:317-346-6176
Practice Address - Fax:317-736-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN022235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty