Provider Demographics
NPI:1710018056
Name:DUNN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DUNN MEMORIAL HOSPITAL
Other - Org Name:DUNN MEMORIAL HOSPITAL - PHYSICIAN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-276-1209
Mailing Address - Street 1:1600 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-4704
Mailing Address - Country:US
Mailing Address - Phone:812-275-3331
Mailing Address - Fax:812-276-1211
Practice Address - Street 1:1600 23RD ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4704
Practice Address - Country:US
Practice Address - Phone:812-275-3331
Practice Address - Fax:812-276-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
940090Medicare ID - Type Unspecified