Provider Demographics
NPI:1972516110
Name:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC.
Entity type:Organization
Organization Name:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:W
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-996-2345
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-996-8476
Mailing Address - Fax:812-996-8497
Practice Address - Street 1:751 W 9TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2609
Practice Address - Country:US
Practice Address - Phone:812-996-0400
Practice Address - Fax:812-996-0653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-15
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062502A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200048850OMedicaid
INCB3118OtherRAILROAD MEDICARE
IN137600Medicare PIN