MEDICARE: THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	11-000079-1	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699834176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY

Provider Business Mailing Address
First Line	:	2940 N CLINTON ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-1910
Country	:	US
Telephone Number	:	260-484-0602
Fax Number	:	260-471-2244

Provider Business Practice Location Address
First Line	:	2940 N CLINTON ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805
Country	:	US
Telephone Number	:	260-484-0602
Fax Number	:	260-471-2244

Authorized Official
Title or Position	:	CFO OF ASC
Name	:	STEVE VAN CAMP
Credential	:	CPA
Telephone Number	:	317-788-2500

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	09/25/2020

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Directions to “THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY ” Practice Location

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