NPIMap

Organization Active NPI

Woodlawn Hospital

Doing business as Fulton County Medical Clinic

  • Family Medicine Physician
  • Fulton, IN
National Provider Identifier
1114254190
Registry record updated Mar 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WOODLAWN HOSPITAL
Doing business as
Fulton County Medical Clinic
Practice address
100 E Dunn Street
Fulton, IN 49631
Phone
(574) 857-5995
Fax
(574) 223-5847
NPI assigned
Nov 11, 2009
Last updated
Mar 20, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
WOODLAWN HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 20, 2019

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

Authorized official

Name
John Kraft
Title
Cfo
Phone
(574) 224-1118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

100 E Dunn Street
Fulton, IN 49631

Mailing address

1400 E 9TH St
Rochester, IN 46975-8931
Phone (574) 233-3141

Other identifiers 1

IdentifierTypeStateIssuer
100269770DMedicaidIN

Other names 1

  • Fulton County Medical Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Woodlawn Hospital26 organizations share this tax ID, including this one
Part of
Woodlawn Hospital

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1257897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553040000000",
    "number": "1114254190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E 9TH ST",
            "city": "ROCHESTER",
            "state": "IN",
            "postal_code": "469758931",
            "telephone_number": "574-233-3141",
            "fax_number": "574-223-5847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E DUNN STREET",
            "city": "FULTON",
            "state": "IN",
            "postal_code": "49631",
            "telephone_number": "574-857-5995",
            "fax_number": "574-223-5847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAWN HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WOODLAWN HOSPITAL",
        "enumeration_date": "2009-11-11",
        "last_updated": "2019-03-20",
        "status": "A",
        "authorized_official_last_name": "KRAFT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "574-224-1118"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100269770D",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fulton County Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fulton County Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fulton, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2019; 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.