=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093715468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAMS COUNTY MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2005
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 PARKVIEW STREET
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46563-1152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-936-9943
-----------------------------------------------------
Fax | 574-936-4310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 MERCER AVENUE PO BOX 151
-----------------------------------------------------
City | DECATAR
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46733-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-724-2145
-----------------------------------------------------
Fax | 574-722-3894
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT TREASURER
-----------------------------------------------------
Name | KYLE SPRUNGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 260-724-2145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 05-000030-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 05-000030-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------