NPIMap

Organization Active NPI

Henry County Memorial Hospital

Doing business as Centerville Family Medicine

  • Family Medicine Physician
  • Richmond, IN
National Provider Identifier
1346867942
Registry record updated Jun 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HENRY COUNTY MEMORIAL HOSPITAL
Doing business as
Centerville Family Medicine
Practice address
4760 National Rd W
Richmond, IN 47374-4745
Phone
(765) 965-6679
NPI assigned
Jun 30, 2020
Last updated
Jun 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2020

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

Authorized official

Name
Carissa Fuller, CPC
Title
Credentialing Coordinator
Phone
(765) 599-3534

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Clinic/Center 261Q00000X NU

Addresses

Primary practice location

4760 National Rd W
Richmond, IN 47374-4745

Mailing address

PO Box 485
New Castle, IN 47362-0485
Phone (765) 521-1516

Other names 1

  • Centerville Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Henry County Memorial Hospital47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1593475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593475200000",
    "number": "1346867942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 485",
            "city": "NEW CASTLE",
            "state": "IN",
            "postal_code": "473620485",
            "telephone_number": "765-521-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4760 NATIONAL RD W",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473744745",
            "telephone_number": "765-965-6679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-30",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "CARISSA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "765-599-3534",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centerville Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; 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.