Provider Demographics
NPI:1013363308
Name:MADISON COUNTY COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:MADISON COUNTY COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-641-7499
Mailing Address - Street 1:1547 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-1917
Mailing Address - Country:US
Mailing Address - Phone:765-641-7499
Mailing Address - Fax:765-356-4647
Practice Address - Street 1:1547 OHIO AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1917
Practice Address - Country:US
Practice Address - Phone:765-641-7499
Practice Address - Fax:765-356-4647
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADISON COUNTY COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200271310AMedicaid
IN151826Medicare UPIN