Provider Demographics
NPI:1427071687
Name:JOHNSON MEMORIAL HOSPITAL.
Entity type:Organization
Organization Name:JOHNSON MEMORIAL HOSPITAL.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERKHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-346-7934
Mailing Address - Street 1:PO BOX 4377
Mailing Address - Street 2:1690 S COUNTY FARM ROAD
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46581-4377
Mailing Address - Country:US
Mailing Address - Phone:574-267-7211
Mailing Address - Fax:574-267-4908
Practice Address - Street 1:220 E DUNN ROAD
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:46552
Practice Address - Country:US
Practice Address - Phone:574-654-7244
Practice Address - Fax:574-654-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-000527-1314000000X
332BN1400X
IN332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100267110AMedicaid
IN155578Medicare Oscar/Certification
IN0435080028Medicare NSC