Healthcare Provider Details

I. General information

NPI: 1730564014
Provider Name (Legal Business Name): COMMUNITY PHYSICIANS OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 CLEARVISTA PKWY SUITE 440
INDIANAPOLIS IN
46256-4673
US

IV. Provider business mailing address

8040 CLEARVISTA PKWY SUITE 440
INDIANAPOLIS IN
46256-4673
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-6024
  • Fax: 317-497-2507
Mailing address:
  • Phone: 317-497-6024
  • Fax: 317-497-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY JAVORKA
Title or Position: COO
Credential:
Phone: 317-621-1591