Provider Demographics
NPI:1538342522
Name:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC
Entity type:Organization
Organization Name:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:W
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-482-2345
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-0310
Mailing Address - Country:US
Mailing Address - Phone:812-481-1655
Mailing Address - Fax:
Practice Address - Street 1:721 W 13TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1855
Practice Address - Country:US
Practice Address - Phone:812-481-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-12
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty