1972500452 NPI number — COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY, INC

Table of content: (NPI 1972500452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972500452 NPI number — COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972500452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6233 RELIABLE PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60686-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-298-3300
Provider Business Mailing Address Fax Number:
765-298-5800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 N MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46011-3453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-298-3300
Provider Business Practice Location Address Fax Number:
765-298-5800
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MILLARD
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE
Authorized Official Telephone Number:
317-355-5860

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100102820A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200817400A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0745740001 . This is a "MEDICARE PART B DME" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200073560A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000097753 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100269520A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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