CMN / EA International Provider Network HOSPITALS/CLINICS As of March 2010 The following document is a list of current providers. The CMN/EA International Provider Network spans approximately 200 countries and territories worldwide with over 2000 hospitals and clinics and over 6000 physicians. *Please note that the physician network is comprised of private practices, as well as physicians affiliated with our network of hospitals and clinics. Prior to seeking treatment, Members must call HCCMIS at 1-800-605-2282 or 1-317-262-2132. A designated member of the Case Management team will coordinate all healthcare services and ensure that direct billing arrangements are in place. Please note that although a Provider may not appear on this list, it does not necessarily mean that direct billing cannot be arranged. In case of uncertainty, it is advised Members call HCCMIS. CMN/EA reserves the right, without notice, to update the International Provider Network CMN/EA International Provider Network INTERNATIONAL PROVIDERS: HOSPITALS/CLINICS FacilitY Name CitY ADDRess Phone NUMBERS AFGHanistan DK-GERman MedicaL DiagnOstic STReet 66 / HOUse 138 / distRict 4 KABUL T: +93 (0) 799 13 62 10 CenteR ZOne1 ALBania T: +355 36 21 21 SURgicaL HOspitaL FOR ADULts TIRana F: +355 36 36 44 T: +355 36 21 21 HOspitaL OF InteRnaL Diseases TIRana F: +355 36 36 44 T: +355 36 21 21 PaediatRic HOspitaL TIRana F: +355 36 36 44 ALGERia 4 LOT. ALLIOULA FOdiL T: +213 (21) 36 28 28 CLiniQUE ChahRAZed ALgeR CHÉRaga F: +213 (21) 36 14 14 4 DJenane AchaBOU CLiniQUE AL AZhaR ALgeR T: +213 21 91 73 96 DELY-IBRahim 16020 BOULEVARD KRim BeLkacem T: +213 34 21 40 22 CLiniQUE DR MOhdeB BeJAÏa IghiL OUAZOUG F: +213 34 21 83 03 LÔtissement ZOne Est T: +213 25 40 08 37 CLiniQUE Amina BLida Chiffa F: +213 25 40 98 79 CitÉ MaaBOUda T: +213 (0) 36 92 43 30 CLiniQUE EL MahaBI SÉtif Setif 19000 F: +213 (0) 36 72 40 41 CitÉ MaaBOUda T: +213 (36) 72 35 35 CLiniQUE Les Pins SÉtif (ROUte de L’UniVERsitÉ) F: +213 (36) 72 35 37 QUARtieR A - face À LA SAA T: +213 (0) 26 21 68 68 CLiniQUE SLimana TIZI OUZOU NOUVELLE ViLLE F: +213 (0) 26 21 28 26 15000 TIZI OUZOU ANDORRA LEER OBSERVACIONES INFORMACION DEL PAIS ANDORRA ANDORRA LA VELLA 60000 ZONA BAJA ESTACION A 50M CAJA CENTRO MEDICO ORDINO-ARCALIS ANDORRA F: 00376850163 ORDINO, 60000 JUNTO TAQUILLAS DE LOS FORFAIT CENTRO MEDICO PAS DE LA CASA ANDORRA F: 00376855512 PAS DE LA CASA, 60000 PISTAS DE ESQUI CENTRO MEDICO DE GRAU ROIG ANDORRA F: 00376759182 PAS DE LA CASA, 60000 ANGola T: +244 226 698 000 CLinica GIRassOL LUanda RUA COmandante Gika 225 F: +244 928 606 779 EUROP Assistance IHS InteRnatiOnaL T: +244 226 698 41 LUanda RUA DO COmandante Gika N°225 Medic F: +244 914 709 730 RUA PedRO FELIX MARchadO 10/12 T: +244 222 39 37 83 MedigROUP CLinica da MUtamBA LUanda CaiXA POstaL 2256 F: +244 222 39 40 86 CLinica SagRada EspeRanca - ILha RUA MOttaLA MOhamede T: +244 (2) 30 90 34 LUanda - NORth ILha de LUanda F: +244 (2) 30 90 33 T: +244 222 469 447 CLinica MULtipeRfiL LUanda RUA MORRO BentO F: +244 222 469 446 RUA Giga 96/100 CLinica DOS PETROLEOS CORPO LUanda T: +244(2) 391488 LUanda CP 1642 20, RUA GARcia Resende CLinic ALVALade LUanda T: +244 222 323 540 BaiRRO ALVALade RUA S10 T: +244 222 397 027 CLinica SegRada EspeRanca - SOUth LUanda SectOR TALatOna - ZOna CCB2 F: +244 222 399 263 AntiGUA & BaRBUDA T: +1 268 (462) 0866 AdeLin CLinic ST JOhn’S FORT ROad F: +1 268 (462) 2386 ARGentina FUndaciON FAVALORO BUenOS AIRes AV. BeLGRanO 1746, (C1093AAS) T: 54 11 4378-1200/1300 SanatORIO de LOS ARCOS BUenOS AIRes AV. JUan B JUstO 909 T: 54 11 52 39 45 25 InstitUTO FLeni BUenOS AIRes AVenida BeLGRanO 1746C 1093AAS T: +54 11 57 77 32 00 San MARtin HOspitaL SchOOL BUenOS AIRes T: 54 (1) 961 6001 CLinica Y MateRnidad SUIZO- AV. PUEYRRedON 1443 CapitaL BUenOS AIRes T:54 11 52 39 60 00 ARgentina FedeRAL CLinica DEL SOL BUenOS AIRes COROneL DiaZ 2211 C1425DQI T: 54 11 48 21 10 00 SanatORIO MateR Dei BUenOS AIRes San MARtin de TOURS 2952 T: 54 11 48 09 55 55 AVE. PatRicias ARgentinas NO. HOspitaL NAVAL BUenOS AIRes T: 54 11 4103 5400 350 PARQUE CentenaRIO SanatORIO Otamendi BUenOS AIRes AZCUenaga 868 T: 54 (1) 961 4061 San MARTÍN 965 (5501) GODOY HOspitaL EspaÑOL de MendOZA MendOZA T: 54 (0261) 449 03 00 CRUZ AVenida de accesO Este 1070 San HOspitaL ItaLianO de MendOZA MendOZA T: 54 (0261) 43 11 000 JOSÈ GUAYmaLLÈN SOciedad EspaÑOLA de SOCORROS MendOZA LaVALLE NO 441 CP 5500 T: 54 (0261) 425 76 69 MUTUOS SanatORIO EL CARmen SALta AVenida BeLGRanO 891 A4400AWG T: (0387) 431 1555 AVenida HipÓLitO YRigOYen N° 273 T: (0387) 431 8800/ SanatORIO EL PARQUE SALta A4402DTC 431 7940 San CARLOS SanatORIO deL SOL AVenida BUstiLLO, KM 1 R8400AEP T: 54 387 431 15 55 de BaRILOche San CARLOS CentRO MÉdicO PediatRicO MELipaL LONQUimaY 3920 MELipaL (8400) T: 54 387 431 88 00 de BaRILOche ARmenia TseReteLI STR., 46 T: +374 (2) 44 95 16 ChiLDRen’S EmeRgencY HOspitaL YEREVAN PROF. NikOLAY DALLakian F: +374 (2) 46 18 41 T: +374 10 23 68 ARABkiR JOint MedicaL CenteR YEREVAN 30 MamikOmiants stReet 83/119/199 NaiRI MedicaL CenteR YEREVAN 21 PARONYan STReet T: +374 10 53 75 00 DAVidashen P/B 25 T: +374 (2) 34 11 44 RadiatiON And BURns CentRE YEREVAN PROF. NicOLai M Ogamasian F: +374 (2) 34 11 44 T: +374 (2) 53 75 21 NaiRI medicaL CentRE YEREVAN paRONYan 21 F: +374 (2) 53 55 14 AmaRanOtsaYin 13 T: +374 (2) 65 09 71 NORK-MARash CARdiac CentRE YEREVAN DR. KARine SARkissian F: +374 (2) 57 83 69 InstitUte Of ORthOP And T: 374 (2) 65 30 71 YEREVAN TRAUmatOLOG F: +374 (2) 63 64 73 T: +374 10 47 06 00 EREBOUni MedicaL CentRE YEREVAN TitO GRadYan STReet 0087 F: +374 10 47 81 19 T: +374 10 63 34 21 Scientific MedicaL EmeRgencY YEREVAN 10 GURJian stReet F: +374 93 64 88 01 T: +374 (2) 28 17 90 MikaeLYan InstitUte OF SURgeRY YEREVAN RUE HasRatYan 9 F: +374 (2) 28 19 70 NORK MARash MedicaL CenteR YEREVAN A. ARmenakYan stReet 13 T: +374 65 09 71 AUstRalia 28 WOODVILLE RD QUeen ELIZABeth HOspitaL AdeLaide T: +61 (2) 95 15 61 11 WOODVILLE west sa 5011 NORth teRRace ROYAL AdeLaide HOspitaL AdeLaide T: +61 (2) 83 82 11 11 adeLaide sa 5000 FLindeRS MedicaL CenteR AdeLaide FLindeRS DRIVE, BedfORD pk, 5042 T: +61 (2) 93 82 22 22 BRisBane HERstON ROad ROYAL BRisBane HOspitaL T: +61 (2) 438 71 11 (QUeensLand) 4029 BRisBane cnR HERstON ROad and BRisBane T: +61 (2) 62 01 61 11 ROYAL ChiLDRen’S HOspitaL BRamdstON TERR (QUeensLand) F: +61 (2) 62 01 62 10 4029 BRisBane CanBERRa HAYden DRIVE T: +61 (2) 62 44 22 22 CALVARY HOspitaL (A C T) BRUce F: +61 (2) 62 81 39 35 CanBERRa YamBA DRIVE T: +61 (62) 81 81 00 CanBERRA HOspitaL (A C T) GARRan Act 2605 F: +61 (62) 81 81 68 CanBERRa STRickLand CR T: +61 (62) 22 66 66 JOhn James HOspitaL (A C T) Deakin F: +61 (62) 22 66 99 CanBERRa GILMORE CRescent NatiOnaL CapitaL PRIVate HOspitaL T: +61 (3) 93 42 40 00 (A C T) GARRan MELBOURne GRattan st T: +61 (7) 36 36 81 11 ROYAL MELBOURne HOspitaL (VictORia) paRKVILLE Vic 3053 F: +61 (7) 32 57 17 65 PERth (W 197 weLLingtON st T: +61 (7) 36 36 37 77 ROYAL PERth HOspitaL AUstRALia) east peRth wa 6004 F: +61 (7) 36 36 72 15 SYDNEY (NEW ROYAL PRince ALFRed CampeRDOwn T: 61 (9) 224 2244 S WALES) SYdneY (New 406 VictORia stReet Saint Vincent HOspitaL T: +61 (8) 82 22 60 00 S WALes) DARLinghURst NSW, 2010 SYdneY (New PRince OF WhaLes HOspitaL Randwick T: 61 (8) 82 22 40 00 S WALes) SYdneY (New ROYAL NORth SHORE HOspitaL ST LeOnaRds, 2065 T: 61 (8) 82 04 55 11 S WALes) AUstRia LandeskRankenhaUS BRUck an deR BRUck an TRagÖsseRstRasse 1 T: +43 (316) 385 MUR deR MUR 8600 F: +43 (316) 383 114 RadLpass STRasse 29 T: +43 (316) 59 89 KRankenhaUS DEUtschLandsBERG DEUtschLandsBERG 8530 F: +43 (316) 551 10 15 OttOkaR KERnstOck-STRasse 18 LandeskRankenhaUS FELDBach FELDBach T: +43 (316) 505 8330 KRankenhaUsgasse 1 T: +43 (316) 7063-0 LandeskRankenhaUS FÜRstenfeLD FÜRstenfeLD 8280 F: +43 (316) 7063-1060 AUenBRUggeRPLatZ 1 T: +43 (316) 7067-725 LandeskRankenhaUS GRAZ GRAZ 8036 F: +43 (316) 7067-707 BeRgstRasse 27 KRankenhaUS deR BaRmheRZigen T: +43 (316) 7066-1999 GRAZ 8020 BRÜdeR F: +43 (316) 7066-1419 EggenBERG Bei GRAZ GÖstingeR STRasse 24 UnfaLLKRankenhaUS deR AUVA GRAZ T: +43 (316) 55 11 00 8020 ELisaBethineRgasse 14 KRankenhaUS deR ELisaBethinen GRAZ T: +43 (3172) 22 14 8020 KRankenhaUS deR BaRmheRZigen MARschaLLgasse 12 T: +43 (3142) 2010 GRAZ BRÜdeR 8020 F: +43 (3142) 2010-2210 ALBERT-SchweitZER-Gasse 22 T: +43 (3152) 899-0 GERiatR. KRankenhaUS D. Stadt GRAZ GRAZ 8020 F: +43 (3152) 899-1127 BeRgstRasse 27-31 KRankenhaUS BaRmheRZige BRÜdeR GRAZ T: +43 (3462) 4411 8010 KRankenhaUspL. 1 T: +43 (3862) 895 LandeskRankenhaUS HARTBERG HARTBERG 8230 F: +43 (3862) 515 61 21 AntON BUchaLka-STRasse 1 KRankenhaUS KapfenBERG GMBH KapfenBERG T: +43 (3862) 20 8605 GaaLERstRasse 10 T: +43 (3842) 4010 LandeskRankenhaUS KnitteLfeLD KnitteLfeLD 8720 F: +43 (3842) 31193 VORdeRNBERgeR STRasse 42 T: +43 (3332) 605 LandeskRankenhaUS LeOBen LeOBen 8700 F: +43 (3332) 605-4108 WieneR PRIVatkLinik T: +43 (3382) 506 WieneR PRIVatkLinik Vienna PELikangasse 15 F: +43 (3382) 506 20 0 1090 LaZARettgasse 16-18 T: +43 (3337) 22 54 GOLdenes KREUZ HOspitaL Vienna 1090 F: +43 (3337) 225 46 0 DOnaUeschingenstRasse 13 UnfaLLKRankenhaUS LORenZ BÖHLER Vienna T: +43 (3512) 707 1200 HeiLigenstÄdeR ST.