Provider Demographics
NPI:1356389498
Name:FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES
Entity type:Organization
Organization Name:FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-949-5500
Mailing Address - Street 1:3852 RELIABLE PARKWAY
Mailing Address - Street 2:PALMYRA FAMILY MEDICINE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0038
Mailing Address - Country:US
Mailing Address - Phone:812-949-5482
Mailing Address - Fax:812-949-5966
Practice Address - Street 1:691 MAIN STREET NE
Practice Address - Street 2:PALMYRA FAMILY MEDICINE
Practice Address - City:PALMYRA
Practice Address - State:IN
Practice Address - Zip Code:47164-8894
Practice Address - Country:US
Practice Address - Phone:812-364-4669
Practice Address - Fax:812-364-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200104040AMedicaid
IN200104040AMedicaid