Healthcare Provider Details

I. General information

NPI: 1225263106
Provider Name (Legal Business Name): COMMUNITY HOSPITALS OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 CLEARVISTA DR SUITE 120
INDIANAPOLIS IN
46256-4699
US

IV. Provider business mailing address

7250 CLEARVISTA DR SUITE 120
INDIANAPOLIS IN
46256-4699
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-2740
  • Fax: 317-621-5658
Mailing address:
  • Phone: 317-621-2740
  • Fax: 317-621-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

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