Provider Demographics
NPI:1710093091
Name:HARRISON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:HARRISON COUNTY HOSPITAL
Other - Org Name:HARRISON CRAWFORD HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-738-4251
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0038
Mailing Address - Country:US
Mailing Address - Phone:812-738-4251
Mailing Address - Fax:812-738-7833
Practice Address - Street 1:368 W OLD STATE ROAD 62
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:IN
Practice Address - Zip Code:47137-2290
Practice Address - Country:US
Practice Address - Phone:812-739-4555
Practice Address - Fax:812-739-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200024140BMedicaid