Provider Demographics
NPI:1386683316
Name:CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.
Entity Type:Organization
Organization Name:CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-667-5330
Mailing Address - Street 1:416 E MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-2015
Mailing Address - Country:US
Mailing Address - Phone:260-665-2141
Mailing Address - Fax:260-665-2879
Practice Address - Street 1:416 E MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2015
Practice Address - Country:US
Practice Address - Phone:260-665-2141
Practice Address - Fax:260-665-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1C16212282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097652OtherBLUE CROSS BLUE SHIELD
IN100267970Medicaid
IN000000097652OtherBLUE CROSS BLUE SHIELD
IN000000097652OtherBLUE CROSS BLUE SHIELD