Provider Demographics
NPI:1790892727
Name:HARRISON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:HARRISON COUNTY HOSPITAL
Other - Org Name:HARRISON COUNTY HOSPITAL PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-738-4251
Mailing Address - Street 1:1141 HOSPITAL DRIVE NW
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2164
Mailing Address - Country:US
Mailing Address - Phone:812-738-7865
Mailing Address - Fax:812-738-7833
Practice Address - Street 1:1141 HOSPITAL DRIVE NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2164
Practice Address - Country:US
Practice Address - Phone:812-738-7865
Practice Address - Fax:812-738-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005073-1207R00000X
IN06-004773-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100268260AMedicaid
KY1065774Medicaid
KY01340306Medicaid
IN36649630'0OtherBLACK LUNG
IN000000054339OtherANTHEM IN
IN151331B000000OtherTRAILBLAZER
KY1065774�Medicaid
INB41630Medicare UPIN
KY01340306�Medicaid
IN=========000OtherCARESOURCE�
IN36649630'0OtherBLACK LUNG