Healthcare Provider Details

I. General information

NPI: 1457515488
Provider Name (Legal Business Name): COMMUNITY HOSPITALS OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 OLIO RD SUITE 330
FISHERS IN
46037-7240
US

IV. Provider business mailing address

13121 OLIO RD SUITE 330
FISHERS IN
46037-7240
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1451
  • Fax: 317-621-1455
Mailing address:
  • Phone: 317-621-1451
  • Fax: 317-621-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01031102A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000000575566
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerANTHEM

VIII. Authorized Official

Name: JEFFERY KIRKHAM
Title or Position: CFO
Credential:
Phone: 317-355-5822