Provider Demographics
NPI:1457366189
Name:COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.
Entity type:Organization
Organization Name:COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACFO
Authorized Official - Prefix:
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:RISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-266-9380
Mailing Address - Street 1:PO BOX 5600
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46895-5600
Mailing Address - Country:US
Mailing Address - Phone:260-373-7008
Mailing Address - Fax:260-373-7059
Practice Address - Street 1:401 N SAWYER RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755
Practice Address - Country:US
Practice Address - Phone:260-355-3304
Practice Address - Fax:260-347-8149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X
IN06-002434-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1516155OtherNCPDP
IN4708OtherPHP IDENTIFICATION #
IN030013800OtherBLACK LUNG ID#
MI304586628Medicaid
WV3810003568Medicaid
FL913710600Medicaid
MI404586600Medicaid
IN000000098231OtherANTHEM IDENTIFICATION #
IN000000098231OtherINDIANA COMP ID#
AK157542105Medicaid
CO54239516Medicaid
IN200287080AMedicaid
IN000000007835OtherMPLAN IDENTIFICATION #
VA010200636Medicaid
AK157542105Medicaid
WV3810003568Medicaid
MI404586600Medicaid
VA010200636Medicaid