Provider Demographics
NPI:1861536930
Name:HENDRICKS COUNTY HOSPITAL
Entity type:Organization
Organization Name:HENDRICKS COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIJANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, NE-BC
Authorized Official - Phone:317-272-7500
Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:STE. 1140
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-839-7200
Mailing Address - Fax:317-837-7926
Practice Address - Street 1:1100 SOUTHFIELD DR
Practice Address - Street 2:STE. 1140
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-4498
Practice Address - Country:US
Practice Address - Phone:317-839-7200
Practice Address - Fax:317-837-7926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDRICKS REGIONAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100442010BMedicaid
IN100442010BMedicaid