Organization
FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY WHITE (CEO)
(765) 825-5131
Entity
Organization
Contact information
Practice address
1941 VIRGINIA AVE, CONNERSVILLE, IN 47331-2833
(765) 825-5131
(765) 827-7733
Mailing address
1941 VIRGINIA AVENUE, CONNERSVILLE, IN 47331
(765) 825-5131
(765) 827-7733
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
050050591
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100268210A
—
IN
01
—
150064
PTAN
IN
Enumeration date
03/18/2006
Last updated
12/26/2017
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