Provider Demographics
NPI:1982930483
Name:JASPER COUNTY HOSPITAL
Entity Type:Organization
Organization Name:JASPER COUNTY HOSPITAL
Other - Org Name:JASPER COUNTY HOSPITAL DEMOTTE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCIAL SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:219-866-5141
Mailing Address - Street 1:1104 E GRACE ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-3296
Mailing Address - Country:US
Mailing Address - Phone:219-866-5141
Mailing Address - Fax:219-866-2014
Practice Address - Street 1:520 S HALLECK STREET
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-8630
Practice Address - Country:US
Practice Address - Phone:219-987-6762
Practice Address - Fax:219-987-6763
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASPER COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-19
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332900000XSuppliersNon-Pharmacy Dispensing Site
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200357640AMedicaid