NPIMap

Organization Active NPI

Fayette Memorial Hospital Association, Inc.

  • Pediatrics Physician
  • Connersville, IN
National Provider Identifier
1891755401
Registry record updated Apr 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC.
Practice address
3542 Western Ave
Connersville, IN 47331-3427
Phone
(765) 827-8090
Fax
(765) 827-8093
NPI assigned
Mar 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2016

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

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

3542 Western Ave
Connersville, IN 47331-3427

Mailing address

1941 Virginia Ave
Connersville, IN 47331-2833
Phone (765) 827-8933

Other identifiers 1

IdentifierTypeStateIssuer
100115030AMedicaidIN

Other names 1

  • Pediatric Health Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fayette Memorial Hospital Association Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

3542 Western Ave
Connersville, IN 47331
Phone (765) 825-5323

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460937600000",
    "number": "1891755401",
    "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": "473312833",
            "telephone_number": "765-827-8933",
            "fax_number": "765-827-7863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3542 WESTERN AVE",
            "city": "CONNERSVILLE",
            "state": "IN",
            "postal_code": "473313427",
            "telephone_number": "765-827-8090",
            "fax_number": "765-827-8093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2016-04-18",
        "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": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100115030A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Health Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Connersville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.