Provider Demographics
NPI:1881966158
Name:HANCOCK REGIONAL HOSPITAL
Entity type:Organization
Organization Name:HANCOCK REGIONAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FACHE
Authorized Official - Phone:317-468-4412
Mailing Address - Street 1:11050 PRESBYTERIAN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-2982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11050 PRESBYTERIAN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-2982
Practice Address - Country:US
Practice Address - Phone:317-823-6841
Practice Address - Fax:317-826-8590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANCOCK REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-02
Last Update Date:2012-06-19
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
IN155167Medicare Oscar/Certification