Provider Demographics
NPI:1477597631
Name:COMMUNITY HOSPITAL OF BREMEN, INC.
Entity type:Organization
Organization Name:COMMUNITY HOSPITAL OF BREMEN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:574-546-2211
Mailing Address - Street 1:1020 HIGH RD
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-1093
Mailing Address - Country:US
Mailing Address - Phone:574-546-2211
Mailing Address - Fax:574-546-4312
Practice Address - Street 1:1020 HIGH RD
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1093
Practice Address - Country:US
Practice Address - Phone:574-546-2211
Practice Address - Fax:574-546-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN140050971275N00000X
IN05-005097-2275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15Z300Medicare Oscar/Certification
IN15Z300Medicare PIN