Provider Demographics
NPI:1962761379
Name:CENTRAL INDIANA-AMG SPECIALTY HOSPITAL, LLC
Entity type:Organization
Organization Name:CENTRAL INDIANA-AMG SPECIALTY HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-9566
Mailing Address - Street 1:101 LA RUE FRANCE STE 500
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3144
Mailing Address - Country:US
Mailing Address - Phone:337-269-9566
Mailing Address - Fax:337-269-9823
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:5TH FLOOR EAST TOWER
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-751-5253
Practice Address - Fax:765-289-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN152025Medicare Oscar/Certification