Organization
FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC.
Active
Other names
Brookville Immediate Care
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL WHITE (CEO)
(765) 827-7987
Entity
Organization
Contact information
Practice address
11137 US HIGHWAY 52 SUITE A, BROOKVILLE, IN 47012
(765) 647-5126
(765) 647-5900
Mailing address
1941 VIRGINIA AVE, CONNERSVILLE, IN 47331
(765) 825-5131
(765) 827-7796
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
050050591
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200061320A
—
IN
05
—
2320330
—
OH
Enumeration date
03/15/2006
Last updated
03/23/2016
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