Basic Information
| Provider Information | |||||||||
| NPI: | 1801997184 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PARKVIEW LAGRANGE HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5600 | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468955600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603737008 | ||||||||
| FaxNumber: | 2603737059 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 N TOWNLINE RD | ||||||||
| Address2: | |||||||||
| City: | LAGRANGE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467611325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604632143 | ||||||||
| FaxNumber: | 2604633190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 01/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | NAFZIGER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP -- CFO | ||||||||
| AuthorizedOfficialTelephone: | 2603737008 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 0186 | IN | Y | Transportation Services | Ambulance | Land Transport |
No ID Information.