Provider Demographics
NPI:1861853574
Name:HENDRICKS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:HENDRICKS COUNTY HOSPITAL
Other - Org Name:HENDRICKS REGIONAL HEALTH BREAST CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NETWORK DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENIEVEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLAYER
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN MBA
Authorized Official - Phone:317-837-5571
Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5570
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:325 WESTFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1497
Practice Address - Country:US
Practice Address - Phone:317-718-9000
Practice Address - Fax:317-718-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063624A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN354590Medicare PIN