# PUTNAM COUNTY HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Waters of Martinsville
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720026180
- **Authorized official:** MR. DENNIS WEATHERFORD (PRESIDENT/CEO)
- **Authorized official phone:** (765) 655-2620

## Contact information

- **Practice address:** 2055 HERITAGE DR, MARTINSVILLE, IN 46151-3158
- **Practice address phone:** (765) 342-3305
- **Practice address fax:** (765) 342-9575
- **Mailing address:** 2055 HERITAGE DR, MARTINSVILLE, IN 46151-3158
- **Mailing address phone:** (765) 342-3305
- **Mailing address fax:** (765) 342-9575

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 05-000096-1 | IN | Yes |

## Other

- **Enumeration date:** 06/04/2006
- **Last updated:** 10/27/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000381423 | ANTHEM BCBS | IN |
| 01 | — | 000000476411 | ANTHEM PT | IN |
| 01 | — | 000000476412 | ATNEHM OT | IN |
| 01 | — | 000000476413 | ANTHEM ST | IN |
| 05 | — | 100290890C | — | IN |