| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 800 W 9th St, Jasper, Indiana |
| Authorized Official Name and Position | Ray Snowden (PRESIDENT & CEO) |
| Authorized Official Contact | 8129962345 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
800 W 9th St Jasper IN 47546-2514 Ph: (812) 996-2345 | 800 W 9th St Jasper IN 47546-2514 Ph: (812) 996-2345 |
| NPI Number | 1366421026 |
|---|---|
| Provider Enumeration Date | 01/11/2006 |
| Last Update Date | 08/13/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366421026 | NPI | - | NPPES |
| 100268610A | Medicaid | IN | |
| 000000097730 | Other | IN | BLUE CROSS PSYCH UNIT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 050051021 (Indiana) | Primary |
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