Basic Information
| Provider Information | |||||||||
| NPI: | 1396895710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 E MAUMEE ST | ||||||||
| Address2: | DEPARTMENT OF PHARMACY | ||||||||
| City: | ANGOLA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467032015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2606675295 | ||||||||
| FaxNumber: | 2606657888 | ||||||||
| Practice Location | |||||||||
| Address1: | 416 E MAUMEE ST | ||||||||
| Address2: | DEPARTMENT OF PHARMACY | ||||||||
| City: | ANGOLA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467032015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2606652141 | ||||||||
| FaxNumber: | 2606657888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | ALDRED | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | VP/COO | ||||||||
| AuthorizedOfficialTelephone: | 2606655330 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | R.PH. | ||||||||
| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 60002416A | IN | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | AC2641858 | 01 | IN | DEA REGISTRATION NUMBER | OTHER | 1517981 | 01 | IN | NABP IDENTIFICATION | OTHER | 200069420A | 05 | IN | MEDICAID | 60002416A | 01 | IN | INDIANA PHARMACY LICENSE | OTHER |