Provider Demographics
NPI:1447467196
Name:PULASKI MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:PULASKI MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CF0
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-946-2100
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:616 E 13TH STREET
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-0279
Mailing Address - Country:US
Mailing Address - Phone:574-946-2100
Mailing Address - Fax:574-946-2129
Practice Address - Street 1:616 E 13TH ST
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-1117
Practice Address - Country:US
Practice Address - Phone:574-946-2100
Practice Address - Fax:574-946-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097769OtherANTHEM
IN15Z305Medicare Oscar/Certification