Organization
FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC.
Active
Other names
Pediatric Health Group
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL WHITE (CEO)
(765) 827-7987
Entity
Organization
Contact information
Practice address
3542 WESTERN AVE, CONNERSVILLE, IN 47331-3427
(765) 827-8090
(765) 827-8093
Mailing address
1941 VIRGINIA AVE, CONNERSVILLE, IN 47331-2833
(765) 827-8933
(765) 827-7863
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100115030A
—
IN
Enumeration date
03/27/2006
Last updated
04/18/2016
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