Provider Demographics
NPI:1336571538
Name:WABASH COUNTY HOSPITAL INC
Entity Type:Organization
Organization Name:WABASH COUNTY HOSPITAL INC
Other - Org Name:WABASH COUNTY HOSPITAL QUICKMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-569-2247
Mailing Address - Street 1:710 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-1914
Mailing Address - Country:US
Mailing Address - Phone:260-563-3131
Mailing Address - Fax:260-569-2410
Practice Address - Street 1:710 N EAST ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1914
Practice Address - Country:US
Practice Address - Phone:260-563-3131
Practice Address - Fax:260-569-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270190Medicaid