Provider Demographics
NPI:1215928536
Name:PERRY COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:PERRY COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:STIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-547-0170
Mailing Address - Street 1:8885 STATE ROAD 237
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-8567
Mailing Address - Country:US
Mailing Address - Phone:812-547-7011
Mailing Address - Fax:812-547-9543
Practice Address - Street 1:18485 STATE RD 37
Practice Address - Street 2:
Practice Address - City:LEOPOLD
Practice Address - State:IN
Practice Address - Zip Code:47551-8072
Practice Address - Country:US
Practice Address - Phone:812-843-3038
Practice Address - Fax:812-843-3084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15D1043196OtherCLIA
KY78904927Medicaid
KY65944290Medicaid
IN000000371434OtherANTHEM
IN200531240AMedicaid
IN230770Medicare PIN