WITHAM MEMORIAL HOSPITAL (NPI# 1013193903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013193903 |
| Entity Type | Organization |
| Organization Name | WITHAM MEMORIAL HOSPITAL |
| Other Organization Name | BRECKENRIDGE HEALTH & REHABILITATION |
| Practice Address |
325 W Northwood Dr Sullivan IN 47882-7515 |
| Mailing Address |
9480 Priority Way West Dr Indianapolis IN 46240-1470 |
| Practice Telephone | 8122683351 |
| Practice Fax Number | 8122683765 |
| Mailing Telephone | 3178181240 |
| Mailing Fax Number | 3178181762 |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2012-10-15 |
| Authorized Official Name | DR. RAYMOND V INGHAM (PRESIDENT, CEO) |
| Authorized Official Telephone | 7654858100 |
| Authorized Official Credential | PH D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 110005251 | IN | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100267010B | 05 |
| Other Name | Type Code |
|---|---|
| BRECKENRIDGE HEALTH & REHABILITATION | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902298557 | Witham Memorial Hospital | Pharmacy | 2705 N Lebanon St Ste 100, Lebanon, IN 46052-8621 | 2015-02-19 |
| 1194115386 | Witham Memorial Hospital | Skilled Nursing Facility | 12315 N Pennsylvania St, Carmel, IN 46032-6600 | 2015-01-27 |
| 1366843716 | Witham Memorial Hospital | Skilled Nursing Facility | 2402 South St, Lafayette, IN 47904-3063 | 2014-09-04 |
| 1942639695 | Witham Memorial Hospital | Skilled Nursing Facility | 2200 S Dixon Rd, Kokomo, IN 46902-6410 | 2013-11-04 |
| 1972939361 | Witham Memorial Hospital | Skilled Nursing Facility | 8405 Clearvista Pl, Indianapolis, IN 46256-3737 | 2013-09-18 |
| 1396171781 | Witham Memorial Hospital | Skilled Nursing Facility | 1635 N Arlington Ave, Indianapolis, IN 46218-5181 | 2013-09-18 |
| 1124360367 | Witham Memorial Hospital | Skilled Nursing Facility | 1 Silvercrest Dr, New Albany, IN 47150-7800 | 2013-03-26 |
| 1144564626 | Witham Memorial Hospital | Skilled Nursing Facility | 20 John Kissinger Dr, Wabash, IN 46992 | 2012-11-21 |
| 1366748386 | Witham Memorial Hospital | Skilled Nursing Facility | 269 Meadowview Dr, Peru, IN 46970-8996 | 2011-02-09 |
| 1306165915 | Witham Memorial Hospital | Skilled Nursing Facility | 814 S 6th St, Monticello, IN 47960-8199 | 2010-05-21 |
| Street Address |
325 W NORTHWOOD DR |
| City | SULLIVAN |
| State | IN |
| Zip Code | 47882-7515 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710952866 | Sullivan Health & Living Center, Inc. | Skilled Nursing Facility | 325 W Northwood Dr, Sullivan, IN 47882-7515 | 2006-02-22 |
| 1255738985 | Indiana Emergency Physicians, LLP | Emergency Medicine | 325 W Northwood Dr, Sullivan, IN 47882-7515 | 2014-11-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659718336 | Neil Lynn Smith | Dentist | 118 S. Court St., Sullivan, IN 47882 | 2013-06-04 |
| 1184888000 | Mary Sherman Hospital | Hospice Care, Community Based | 817 North Section Street, Suite A, Sullivan, IN 47882 | 2008-07-10 |
| 1003838194 | Johnson Memorial Hospital | Durable Medical Equipment & Medical Supplies | 505 West Wolfe Street, Sullivan, IN 47882 | 2006-07-24 |
| 1255580593 | Daniel Choyce Callahan | Psychiatry & Neurology | 2204 N Section St, Sullivan, IN 47882 | 2008-09-11 |
| 1851394175 | Van Evanoff Jr. | Pain Medicine | 2204 N Section St, Suite B, Sullivan, IN 47882-0010 | 2005-05-31 |
| 1982780748 | Associated Physicians & Surgeons Clinic, LLC | Obstetrics & Gynecology | 2204 N Section St, Suite B, Sullivan, IN 47882-0010 | 2006-10-27 |
| 1871996199 | Sullivan Family Dentistry, LLC | Dentist | 2186 N Hospital Blvd., Suite 1, Sullivan, IN 47882-0468 | 2014-10-01 |
| 1487828455 | Kortni Reann Martindale | Speech-Language Pathologist | 368 W Indiana Ave, Sullivan, IN 47882-1117 | 2008-04-21 |
| 1831280585 | Southwest School Corporation | Local Education Agency (LEA) | 110 N Main St, Sullivan, IN 47882-1225 | 2006-09-27 |
| 1780717637 | Brian K Grindstaff | Chiropractor | 210 N Section St Unit C, Sullivan, IN 47882-1237 | 2007-03-13 |
| Find all providers in zip 47882 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568419232 | Sullivan Operations, LLC | Skilled Nursing Facility | 875 Dunsford Dr, Sullivan, MO 63080-1238 | 2006-05-28 |
| 1417913583 | Sullivan Hco, LLC | Skilled Nursing Facility | 11 Hawthorne Ln, Sullivan, IL 61951-9490 | 2006-04-26 |
| 1710952866 | Sullivan Health & Living Center, Inc. | Skilled Nursing Facility | 325 W Northwood Dr, Sullivan, IN 47882-7515 | 2006-02-22 |
| 1194703702 | Petersen Health Care Vii LLC | Skilled Nursing Facility | 1 Masonic Way, Sullivan, IL 61951-9467 | 2006-01-04 |
| 1811984644 | Eastview Terrace | Skilled Nursing Facility | 100 Eastview Pl, Sullivan, IL 61951-1674 | 2005-10-06 |
| 1063419505 | Community Care Ctr of Sullivan, Inc | Skilled Nursing Facility | 940 Mattox Dr, Sullivan, MO 63080-2364 | 2005-06-30 |
| 1063045227 | Eastview Hco, LLC | Skilled Nursing Facility | 100 Eastview Pl, Sullivan, IL 61951-1674 | 2020-02-17 |
| 1386277556 | Sullivan Hco, LLC | Skilled Nursing Facility | 11 Hawthorne Ln, Sullivan, IL 61951-9490 | 2020-02-17 |
| 1609027846 | Petersen Health Care, Inc | Skilled Nursing Facility | 100 Eastview Pl, Sullivan, IL 61951-1674 | 2008-10-07 |
| 1376794511 | Petersen Health Care II, Inc. | Skilled Nursing Facility | 11 Hawthorne Ln, Sullivan, IL 61951-9490 | 2008-10-07 |
| Find all providers in SULLIVAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.