National Provider Identifier Database

FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC
Urgent Care


Contact Information

FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC.
11137 US HIGHWAY 52 SUITE A
BROOKVILLE, IN47012
Phone: 765-647-5126
Fax: 765-647-5900
Website:
Specialty Taxonomy Code
* Urgent Care 261QU0200X

* Indicates primary specialty

NPI Profile & details for FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC.

NPI Number 1073582730
Legal business name
LBN
FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC.
Authorized official RANDALL WHITE - (CEO)
Entity Organization
Organization subpart No
Enumeration date 03/15/2006
Last updated 03/23/2016 - About 10 years ago
Sole proprietor1 Not specified
Identifiers
  • IN License #: 050050591
  • IN Medicaid: 200061320A
  • OH Medicaid: 2320330

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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