Provider Demographics
NPI:1982645404
Name:MAJOR HOSPITAL
Entity Type:Organization
Organization Name:MAJOR HOSPITAL
Other - Org Name:THE WATERS OF COVINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-398-5255
Mailing Address - Street 1:240 FENCL LANE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-2067
Mailing Address - Country:US
Mailing Address - Phone:708-449-1900
Mailing Address - Fax:708-449-1500
Practice Address - Street 1:1600 E. LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1715
Practice Address - Country:US
Practice Address - Phone:765-793-4818
Practice Address - Fax:765-793-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000128-1314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000381422OtherANTHEM BCBS
IN000000476420OtherANTHEM BCBS PT
IN000000476422OtherANTHEM BCBS ST
IN100289650CMedicaid
IN000000476421OtherANTHEM BCBS OT
IN100289650CMedicaid
IN000000476421OtherANTHEM BCBS OT
155223Medicare Oscar/Certification