Provider Demographics
NPI:1790776128
Name:JOHNSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JOHNSON MEMORIAL HOSPITAL
Other - Org Name:GREENWOOD VILLAGE SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERKHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-346-7939
Mailing Address - Street 1:295 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-2440
Mailing Address - Country:US
Mailing Address - Phone:317-865-4654
Mailing Address - Fax:317-859-4436
Practice Address - Street 1:295 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-2440
Practice Address - Country:US
Practice Address - Phone:317-865-4654
Practice Address - Fax:317-859-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN04-000010-1313M00000X
IN16-000010-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1000453660Medicaid
IN155026Medicare Oscar/Certification
IN1000453660Medicaid