MEDICARE: ADAMS COUNTY MEMORIAL HOSPITAL

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	110005251	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	:	1013193903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAMS COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	1100 MERCER AVENUE
Second Line	:
City	:	DECATUR
State	:	IN
Zip	:	46733-2303
Country	:	US
Telephone Number	:	260-724-2145
Fax Number	:	317-818-1762

Provider Business Practice Location Address
First Line	:	325 WEST NORTHWOOD DRIVE
Second Line	:
City	:	SULLIVAN
State	:	IN
Zip	:	47882-7515
Country	:	US
Telephone Number	:	812-268-3351
Fax Number	:	812-268-3765

Authorized Official
Title or Position	:	CFO
Name	:	MR. DANE E WHEELER
Credential	:	CPA
Telephone Number	:	260-724-2145

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	08/15/2022

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Directions to “ADAMS COUNTY MEMORIAL HOSPITAL ” Practice Location

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