Provider Demographics
NPI:1396895710
Name:CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.
Entity type:Organization
Organization Name:CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALDRED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:260-665-5330
Mailing Address - Street 1:416 E MAUMEE ST
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-2015
Mailing Address - Country:US
Mailing Address - Phone:260-667-5295
Mailing Address - Fax:260-665-7888
Practice Address - Street 1:416 E MAUMEE ST
Practice Address - Street 2:DEPARTMENT OF PHARMACY
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:260-665-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60002416A282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1517981OtherNABP IDENTIFICATION
IN200069420AMedicaid
IN60002416AOtherINDIANA PHARMACY LICENSE
IN60002416AOtherINDIANA PHARMACY LICENSE