Provider Demographics
NPI:1801137948
Name:JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORGEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-522-0172
Mailing Address - Street 1:4301 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1190
Mailing Address - Country:US
Mailing Address - Phone:765-282-0053
Mailing Address - Fax:765-282-3290
Practice Address - Street 1:4301 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1190
Practice Address - Country:US
Practice Address - Phone:765-282-0053
Practice Address - Fax:765-282-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100291200CMedicaid
155242Medicare Oscar/Certification