Healthcare Provider Details

I. General information

NPI: 1578544896
Provider Name (Legal Business Name): COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N MADISON AVE
ANDERSON IN
46011-3453
US

IV. Provider business mailing address

6233 RELIABLE PARKWAY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 317-802-6314
  • Fax: 317-870-0499
Mailing address:
  • Phone: 317-802-6314
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JOHN HARRIS
Title or Position: CEO
Credential:
Phone: 765-298-5120