Provider Demographics
NPI:1306033329
Name:COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-983-8300
Mailing Address - Street 1:450 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-8531
Mailing Address - Country:US
Mailing Address - Phone:269-983-8300
Mailing Address - Fax:
Practice Address - Street 1:450 MEDICAL PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-8531
Practice Address - Country:US
Practice Address - Phone:269-463-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0201111141OtherBCBSM PIN
MION78160Medicare PIN