MEDICARE: COMMUNITY MEDICAL CENTER OF SHIPSHEWANA

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	261QP2300X	Primary Care Clinic/Center	50003152A	IN

General Provider Information

NPI Number	:	1538225867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MEDICAL CENTER OF SHIPSHEWANA

Provider Business Mailing Address
First Line	:	PO BOX 187
Second Line	:
City	:	SHIPSHEWANA
State	:	IN
Zip	:	46565-0187
Country	:	US
Telephone Number	:	260-768-4182
Fax Number	:	260-768-4357

Provider Business Practice Location Address
First Line	:	660 S VAN BUREN ST
Second Line	:
City	:	SHIPSHEWANA
State	:	IN
Zip	:	46565-9098
Country	:	US
Telephone Number	:	260-768-4182
Fax Number	:	260-768-4357

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTINE MARGART HAMILTON
Credential	:	D.O.
Telephone Number	:	260-768-4182

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	08/22/2020

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