Healthcare Provider Details

I. General information

NPI: 1649417262
Provider Name (Legal Business Name): COMMUNITY HOSPITALS OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10122 E 10TH STREET SUITE 220
INDIANAPOLIS IN
46229-2664
US

IV. Provider business mailing address

10122 E 10TH STREET SUITE 220
INDIANAPOLIS IN
46229-2664
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-2200
  • Fax: 317-355-8750
Mailing address:
  • Phone: 317-355-2200
  • Fax: 317-355-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

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