Healthcare Provider Details

I. General information

NPI: 1811121189
Provider Name (Legal Business Name): COMMUNITY HOSPITALS OF INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 CLEARVISTA DRIVE SUITE 100
INDIANAPOLIS IN
46256-4640
US

IV. Provider business mailing address

7250 CLEARVISTA DRIVE SUITE 100
INDIANAPOLIS IN
46256-4640
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-5673
  • Fax: 317-621-6040
Mailing address:
  • Phone: 317-621-5673
  • Fax: 317-621-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

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