Provider Demographics
NPI:1912947490
Name:PUTNAM COUNTY HOSPITAL
Entity Type:Organization
Organization Name:PUTNAM COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BORUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-655-2621
Mailing Address - Street 1:1542 S BLOOMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-2212
Mailing Address - Country:US
Mailing Address - Phone:765-653-5121
Mailing Address - Fax:765-655-2625
Practice Address - Street 1:1542 S BLOOMINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2212
Practice Address - Country:US
Practice Address - Phone:765-653-5121
Practice Address - Fax:765-655-2625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUTNAM COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06 004765-2275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100268680AMedicaid
IN000000097812OtherBLUE CROSS, ANTHEM
IN100268700AMedicaid
IN000000097812OtherBLUE CROSS, ANTHEM
IN100268700AMedicaid
IN15Z333Medicare Oscar/Certification