MEDICARE: COMMUNITY HOSPITALS OF INDIANA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1639122518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HOSPITALS OF INDIANA, INC

Provider Business Mailing Address
First Line	:	11911 N MERIDIAN ST
Second Line	:	SUITE 150
City	:	CARMEL
State	:	IN
Zip	:	46032-6904
Country	:	US
Telephone Number	:	317-621-6701
Fax Number	:	317-621-6707

Provider Business Practice Location Address
First Line	:	11911 N MERIDIAN ST
Second Line	:	SUITE 150
City	:	CARMEL
State	:	IN
Zip	:	46032-6904
Country	:	US
Telephone Number	:	317-621-6701
Fax Number	:	317-621-6707

Authorized Official
Title or Position	:	CFO
Name	:	MR. JEFFERY L KIRKHAM
Credential	:
Telephone Number	:	317-355-5822

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	06/16/2010

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Directions to “COMMUNITY HOSPITALS OF INDIANA, INC ” Practice Location

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