Provider Demographics
NPI:1740466770
Name:PULASKI MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:PULASKI MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:MALOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-946-2100
Mailing Address - Street 1:4600 EAST JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4467
Mailing Address - Country:US
Mailing Address - Phone:765-282-1416
Mailing Address - Fax:765-289-7190
Practice Address - Street 1:4600 EAST JACKSON STREET
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4467
Practice Address - Country:US
Practice Address - Phone:765-282-1416
Practice Address - Fax:765-289-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN070002693314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100267720BMedicaid
IN100267720BMedicaid