Healthcare Provider Details

I. General information

NPI: 1669951471
Provider Name (Legal Business Name): COMMUNITY HEALTH NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 CLEARVISTA DR STE 140
INDIANAPOLIS IN
46256-4640
US

IV. Provider business mailing address

6233 RELIABLE PARKWAY
CHICAGO IL
60682-0062
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-3100
  • Fax: 317-621-4298
Mailing address:
  • Phone: 317-355-4992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMY C SPROUSE
Title or Position: DIRECTOR OF REIMBURSMENT
Credential:
Phone: 317-355-4992