Provider Demographics
NPI:1902864325
Name:JASPER COUNTY HOSPITAL
Entity Type:Organization
Organization Name:JASPER COUNTY HOSPITAL
Other - Org Name:JASPER COUNTY HOSPITAL HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCIAL SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:219-866-5141
Mailing Address - Street 1:1104 E GRACE ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-3211
Mailing Address - Country:US
Mailing Address - Phone:219-866-5141
Mailing Address - Fax:219-866-3234
Practice Address - Street 1:1104 E GRACE ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-3211
Practice Address - Country:US
Practice Address - Phone:219-866-5141
Practice Address - Fax:219-866-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-005072-2332900000X, 332B00000X, 332BN1400X, 332BP3500X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332900000XSuppliersNon-Pharmacy Dispensing Site
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100264290AMedicaid
IN000000097206OtherBLUE CROSS
IN100143100AMedicaid
IN128886900OtherOFFICE OF WORKMANS COMP
IN11821OtherARNETT
IN100143100AMedicaid