Basic Information
| Provider Information | |||||||||
| NPI: | 1689696148 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADAMS COUNTY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 MERCER AVENUE | ||||||||
| Address2: | P.O. BOX 151 | ||||||||
| City: | DECATUR | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607242145 | ||||||||
| FaxNumber: | 2607283867 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 MERCER AVE | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467332303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607242145 | ||||||||
| FaxNumber: | 2607283867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 10/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | WHEELER | ||||||||
| AuthorizedOfficialFirstName: | DANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2607242145 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 275N00000X | N | Hospital Units | Medicare Defined Swing Bed Unit | 3416L0300X | IN | N | Transportation Services | Ambulance | Land Transport | 343900000X | N | Transportation Services | Non-emergency Medical Transport (VAN) | 282NC0060X | 060047471 | IN | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 100268270A | 05 | IN | MEDICAID | 000000097902 | 01 | IN | BLUE CROSS | OTHER | 100146660A | 05 | IN | MEDICAID |