Healthcare Provider Details

I. General information

NPI: 1881078202
Provider Name (Legal Business Name): COMMUNITY PHYSICIANS OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 GUION RD SUITE 230B
INDIANAPOLIS IN
46222-1691
US

IV. Provider business mailing address

3660 GUION RD SUITE 230B
INDIANAPOLIS IN
46222-1691
US

V. Phone/Fax

Practice location:
  • Phone: 317-644-5005
  • Fax: 317-644-5006
Mailing address:
  • Phone: 317-644-5005
  • Fax: 317-644-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

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