Organization
IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Active
Other names
IMH Kentland Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY L SMITH (COO)
81584327967
Entity
Organization
Contact information
Practice address
303 N 7TH ST, KENTLAND, IN 47951-1379
(219) 474-5464
(219) 474-3603
Mailing address
303 N 7TH ST, KENTLAND, IN 47951-1379
(219) 474-5464
(219) 474-3603
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003815082
BLUE CROSS BLUE SHIELD
IL
05
—
200133940A
—
IN
Enumeration date
07/17/2006
Last updated
01/17/2017
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