Provider Demographics
NPI:1053358960
Name:DAVIESS COUNTY HOSPITAL
Entity type:Organization
Organization Name:DAVIESS COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMEBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-254-2760
Mailing Address - Street 1:1029 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-3301
Mailing Address - Country:US
Mailing Address - Phone:765-825-0543
Mailing Address - Fax:765-825-0794
Practice Address - Street 1:1029 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-3301
Practice Address - Country:US
Practice Address - Phone:765-825-0543
Practice Address - Fax:765-825-0794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15-000316-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100286370AMedicaid
155491Medicare Oscar/Certification
155491AMedicare Oscar/Certification