NPIMap

Organization Active NPI

Witham Memorial Hospital

  • Community/Retail Pharmacy
  • Lebanon, IN
National Provider Identifier
1902298557
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60006428A Issued in IN
Legal business name
WITHAM MEMORIAL HOSPITAL
Practice address
2705 N Lebanon St Ste 100
Lebanon, IN 46052-8621
Phone
(765) 483-3900
Fax
(765) 483-3909
NPI assigned
Feb 19, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Authorized official

Name
Paul Shay
Title
Pharmacy Manager
Phone
(765) 483-3900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 60006428A IN Primary

Addresses

Primary practice location

2705 N Lebanon St Ste 100
Lebanon, IN 46052-8621

Mailing address

2705 N Lebanon St
Ste 100
Lebanon, IN 46052-8621
Phone (765) 483-3900

Other identifiers 2

IdentifierTypeStateIssuer
2147853OtherPK
300067193MedicaidIN

Other names 1

  • Pavilion Pointe Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hoosier Enterprises II Inc37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Locations

2705 N Lebanon St
Ste 100
Lebanon, IN 46052
Phone (765) 483-3900

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1424304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679356800000",
    "number": "1902298557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 N LEBANON ST",
            "address_2": "STE 100",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460528621",
            "telephone_number": "765-483-3900",
            "fax_number": "765-483-3909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 N LEBANON ST STE 100",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460528621",
            "telephone_number": "765-483-3900",
            "fax_number": "765-483-3909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WITHAM MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-19",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A",
        "authorized_official_last_name": "SHAY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "765-483-3900"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006428A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147853",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300067193",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pavilion Pointe Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pavilion Pointe Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; 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.