Provider Demographics
NPI:1922196229
Name:INDIANA UNIVERSITY HEALTH WHITE MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH WHITE MEMORIAL HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-583-7111
Mailing Address - Street 1:720 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-8182
Mailing Address - Country:US
Mailing Address - Phone:574-583-7111
Mailing Address - Fax:574-583-1703
Practice Address - Street 1:720 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-8182
Practice Address - Country:US
Practice Address - Phone:574-583-7111
Practice Address - Fax:574-583-1703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA UNIVERSITY HEALTH WHITE MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60004820A332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097136OtherBLUE CROSS DME
IN201026750AMedicaid
IN201026750AMedicaid