Basic Information
| Provider Information | |||||||||
| NPI: | 1891922639 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY | ||||||||
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| OtherOrganizationName: | COMMUNITY RHEUMATOLOGY OF ANDERSON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210A MEDICAL ARTS BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652984050 | ||||||||
| FaxNumber: | 7652984960 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210A MEDICAL ARTS BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652984050 | ||||||||
| FaxNumber: | 7652984960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2009 | ||||||||
| LastUpdateDate: | 10/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7652985286 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 200949420A | 05 | IN | MEDICAID |