Organization Name: | COMMUNITY MEDICAL CENTER OF SHIPSHEWANA |
NPI Number: | 1538225867 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTINE MARGART HAMILTON (PRESIDENT) |
Mailing Address: | 660 S Van Buren St Shipshewana |
State: | IN US |
Postal Code: | 465659098 |
Phone Number: | 2607684182 |
Fax Number: | 2607684357 |
NPI Enumeration Date: | 12/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 50003152A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |