Basic Information
Provider Information
NPI: 1417440264
EntityType: 2
ReplacementNPI:  
OrganizationName: CAMERON MEMORIAL COMMUNITY HOSPITAL INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CAMERON OB/GYN
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 416 E MAUMEE ST
Address2:  
City: ANGOLA
State: IN
PostalCode: 467032001
CountryCode: US
TelephoneNumber: 2606675133
FaxNumber: 2606657893
Practice Location
Address1: 306 E MAUMEE ST STE 101
Address2:  
City: ANGOLA
State: IN
PostalCode: 467032037
CountryCode: US
TelephoneNumber: 2606675670
FaxNumber: 2606675680
Other Information
ProviderEnumerationDate: 06/07/2018
LastUpdateDate: 05/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ALCAZAR
AuthorizedOfficialFirstName: CARLOS
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP/CFO
AuthorizedOfficialTelephone: 2606675133
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

No ID Information.


Home