Provider Demographics
NPI:1174526289
Name:CAMERON MEMORIAL COMMUNITY HOSPITAL, INC
Entity type:Organization
Organization Name:CAMERON MEMORIAL COMMUNITY HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-665-2141
Mailing Address - Street 1:416 E MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-2015
Mailing Address - Country:US
Mailing Address - Phone:260-665-2141
Mailing Address - Fax:260-665-8608
Practice Address - Street 1:416 E MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2015
Practice Address - Country:US
Practice Address - Phone:260-665-2141
Practice Address - Fax:260-665-8608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMERON MEMORIAL COMMUNITY HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-005308-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1174526289OtherPECOS
IN200056150AMedicaid
IN000000097654OtherBLUE CROSS BLUE SHIELD PI
IN100263930AMedicaid
IN100263930AMedicaid
IN1174526289OtherPECOS