Provider Demographics
NPI:1477699460
Name:ADAMS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ADAMS COUNTY MEMORIAL HOSPITAL
Other - Org Name:OAK VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:260-724-2145
Mailing Address - Street 1:1100 MERCER AVENUE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733
Mailing Address - Country:US
Mailing Address - Phone:260-724-2145
Mailing Address - Fax:
Practice Address - Street 1:200 WEST FOURTH DTREET
Practice Address - Street 2:
Practice Address - City:OAKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47561-8081
Practice Address - Country:US
Practice Address - Phone:812-745-2360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-000517-1314000000X
IN13-000517-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000304243OtherBLUE CROSS BLUE SHIELD
IN100266770 AMedicaid