Provider Demographics
NPI:1891922639
Name:COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY
Other - Org Name:COMMUNITY RHEUMATOLOGY OF ANDERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-298-5286
Mailing Address - Street 1:1210A MEDICAL ARTS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-3437
Mailing Address - Country:US
Mailing Address - Phone:765-298-4050
Mailing Address - Fax:765-298-4960
Practice Address - Street 1:1210A MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3437
Practice Address - Country:US
Practice Address - Phone:765-298-4050
Practice Address - Fax:765-298-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200949420AMedicaid
IN262600Medicare PIN