Basic Information
| Provider Information | |||||||||
| NPI: | 1972500452 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6233 RELIABLE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606860001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652983300 | ||||||||
| FaxNumber: | 7652985800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 N MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652983300 | ||||||||
| FaxNumber: | 7652985800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | MILLARD | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3173555860 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100102820A | 05 | IN | MEDICAID | 200817400A | 05 | IN | MEDICAID | 0745740001 | 01 | IN | MEDICARE PART B DME | OTHER | 200073560A | 05 | IN | MEDICAID | 000000097753 | 01 | IN | ANTHEM | OTHER | 100269520A | 05 | IN | MEDICAID |