Provider Demographics
NPI:1366741092
Name:JAY COUNTY HOSPITAL
Entity type:Organization
Organization Name:JAY COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-726-7131
Mailing Address - Street 1:510 W VOTAW ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-1322
Mailing Address - Country:US
Mailing Address - Phone:260-726-2890
Mailing Address - Fax:260-726-3131
Practice Address - Street 1:510 W VOTAW ST
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1322
Practice Address - Country:US
Practice Address - Phone:260-726-2890
Practice Address - Fax:260-726-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty