Healthcare Provider Details

I. General information

NPI: 1194753103
Provider Name (Legal Business Name): COMMUNITY HOSPITAL OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7165 CLEARVISTA WAY PSYCH PAVILION
INDIANAPOLIS IN
46256-1695
US

IV. Provider business mailing address

PO BOX 19751 PATIENT ACCOUNTS LOWER LEVEL
INDIANAPOLIS IN
46219-0751
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-5837
  • Fax: 317-355-2205
Mailing address:
  • Phone: 317-355-5837
  • Fax: 317-355-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS P FISCHER
Title or Position: CHIEF FINANCIAL OFFICER
Credential: JCPA
Phone: 317-355-4887