Fayette Memorial Hospital Association Inc.

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

License

050050591 Issued in IN

Legal business name

FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC.

Doing business as

Brookville Immediate Care

Practice address

11137 US Highway 52 Suite a
Brookville, IN 47012

Phone

(765) 647-5126

Fax

(765) 647-5900

NPI assigned

Mar 15, 2006

Last updated

Mar 23, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Randall White

Title

Ceo

Phone

(765) 827-7987

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Brookville Immediate Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1073582730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 VIRGINIA AVE",
            "city": "CONNERSVILLE",
            "state": "IN",
            "postal_code": "47331",
            "telephone_number": "765-825-5131",
            "fax_number": "765-827-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11137 US HIGHWAY 52 SUITE A",
            "city": "BROOKVILLE",
            "state": "IN",
            "postal_code": "47012",
            "telephone_number": "765-647-5126",
            "fax_number": "765-647-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "765-827-7987"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "IN",
            "license": "050050591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200061320A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2320330",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookville Immediate Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas E Edwards, O.D.
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• Urgent Care Clinic/Center in Brookville, IN
• Providers in Brookville, IN by specialty
• Urgent Care Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.