COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.

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: PARKVIEW NOBLE HOSPITAL
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: SVP -- CFO
• Authorized Official - First Name: JEANNE
• Authorized Official - Last Name: WICKENS
• Authorized Official - Phone: 260-266-9313
• Mailing Address - Street 1: PO BOX 5600
• 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 - 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: 2023-10-17

Provider Licenses

State	License ID	Taxonomies
IN	06-002434-1	282N00000X
		3336I0012X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	3336I0012X	Suppliers	Pharmacy	Institutional Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	000000098231	Other	ANTHEM IDENTIFICATION #
IN	000000007835	Other	MPLAN IDENTIFICATION #
VA	010200636	Medicaid
	1516155	Other	NCPDP
IN	4708	Other	PHP IDENTIFICATION #
IN	030013800	Other	BLACK LUNG ID#
IN	200287080A	Medicaid
WV	3810003568	Medicaid
MI	304586628	Medicaid
FL	913710600	Medicaid
AK	157542105	Medicaid
IN	000000098231	Other	INDIANA COMP ID#
MI	404586600	Medicaid
CO	54239516	Medicaid
AK	157542105	Medicaid
WV	3810003568	Medicaid
MI	404586600	Medicaid
VA	010200636	Medicaid