Provider Demographics
NPI:1255525721
Name:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA INC.
Entity type:Organization
Organization Name:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:W
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-482-2345
Mailing Address - Street 1:303 NORTH MERIDIAN STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47541
Mailing Address - Country:US
Mailing Address - Phone:812-536-3943
Mailing Address - Fax:
Practice Address - Street 1:303 NORTH MERIDIAN STREET
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:IN
Practice Address - Zip Code:47541
Practice Address - Country:US
Practice Address - Phone:812-536-3943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE COMPNAY OF MARY HOSPITAL OF INDIANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-28
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCB3118OtherRAILROAD MEDICARE
IN137600Medicare PIN