Provider Demographics
NPI:1750381596
Name:JOHNSON MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:JOHNSON MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PATIENT ACCOUNTS AND ADMIS
Authorized Official - Prefix:MS
Authorized Official - First Name:L
Authorized Official - Middle Name:INEZ
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-738-7878
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-0669
Mailing Address - Country:US
Mailing Address - Phone:317-738-7878
Mailing Address - Fax:317-738-7872
Practice Address - Street 1:1125 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2140
Practice Address - Country:US
Practice Address - Phone:317-738-7878
Practice Address - Fax:317-738-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2008-01-14
Deactivation Date:2006-12-12
Deactivation Code:
Reactivation Date:2008-01-14
Provider Licenses
StateLicense IDTaxonomies
IN005001282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN940990Medicare PIN