Provider Demographics
NPI:1538225867
Name:COMMUNITY MEDICAL CENTER OF SHIPSHEWANA
Entity type:Organization
Organization Name:COMMUNITY MEDICAL CENTER OF SHIPSHEWANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARGART
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:260-768-4182
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:SHIPSHEWANA
Mailing Address - State:IN
Mailing Address - Zip Code:46565-0187
Mailing Address - Country:US
Mailing Address - Phone:260-768-4182
Mailing Address - Fax:260-768-4357
Practice Address - Street 1:660 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565-9098
Practice Address - Country:US
Practice Address - Phone:260-768-4182
Practice Address - Fax:260-768-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003152A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN461590Medicare ID - Type Unspecified