Healthcare Provider Details

I. General information

NPI: 1902017080
Provider Name (Legal Business Name): COMMUNITY HOSPITAL OF BREMEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2024
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 HIGH ROAD
BREMEN IN
46506
US

IV. Provider business mailing address

1020 HIGH ROAD P.O. BOX 8
BREMEN IN
46506
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-2211
  • Fax: 574-546-4312
Mailing address:
  • Phone: 574-546-2211
  • Fax: 574-546-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IRENE MAFFETONE
Title or Position: CONTRACTING SPECIALIST
Credential:
Phone: 574-647-1040