| Organization Name: | SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. |
| NPI Number: | 1508810912 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CLIFFORD MARTIN (EXECUTIVE MEDICAL DIRECTOR) |
| Mailing Address: | 1120 W South St Bremen |
| State: | IN US |
| Postal Code: | 465061849 |
| Phone Number: | 5743357800 |
| Fax Number: | 5743350756 |
| NPI Enumeration Date: | 05/20/2006 |
| NPI Last Update Date: | 09/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |