Provider Demographics
NPI:1396871299
Name:ADAMS COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:ADAMS COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:SECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-724-2145
Mailing Address - Street 1:1100 MERCER AVE
Mailing Address - Street 2:PO BOX 151
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2303
Mailing Address - Country:US
Mailing Address - Phone:260-724-2145
Mailing Address - Fax:260-724-2153
Practice Address - Street 1:1100 MERCER AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2303
Practice Address - Country:US
Practice Address - Phone:260-724-2145
Practice Address - Fax:260-724-2153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAMS COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000232A332B00000X, 332BC3200X, 332BN1400X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100338630AMedicaid
IN0958160002Medicare ID - Type Unspecified