Provider Demographics
NPI:1245952480
Name:PULASKI MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:PULASKI MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:MALOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-946-2103
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-0279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:735 WEST MONTGOMERY STREET
Practice Address - Street 2:
Practice Address - City:FRANCESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47946
Practice Address - Country:US
Practice Address - Phone:574-946-2108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULASKI MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-14
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy