Provider Demographics
NPI:1396783239
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 1:3844 RELIABLE PARKWAY
Mailing Address - Street 2:FLOYD MEMORIAL 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 1:5300 STATE ROAD 64
Practice Address - Street 2:FLOYD MEMORIAL FAMILY MEDICINE
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9178
Practice Address - Country:US
Practice Address - Phone:812-923-4200
Practice Address - Fax:812-923-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1001Z8520AMedicaid
331220Medicare ID - Type Unspecified