Provider Demographics
NPI:1902033582
Name:INDIANA UNIVERSITY HEALTH STARKE HOSPITAL LLC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH STARKE HOSPITAL LLC
Other - Org Name:CNI STARKE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:FELTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-772-1130
Mailing Address - Street 1:102 E CULVER RD
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-2216
Mailing Address - Country:US
Mailing Address - Phone:574-772-6231
Mailing Address - Fax:574-772-5948
Practice Address - Street 1:102 E CULVER RD
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-2216
Practice Address - Country:US
Practice Address - Phone:574-772-6231
Practice Address - Fax:574-772-5948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13-005091-1282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN150102Medicare Oscar/Certification