Healthcare Provider Details

I. General information

NPI: 1154585826
Provider Name (Legal Business Name): COMMUNITY HOSPITALS OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9669 E 146TH ST SUITE 250
NOBLESVILLE IN
46060-5004
US

IV. Provider business mailing address

9669 E 146TH ST SUITE 250
NOBLESVILLE IN
46060-5004
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1340
  • Fax: 317-621-1341
Mailing address:
  • Phone: 317-621-1340
  • Fax: 317-621-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number02002532A
License Number StateIN

VIII. Authorized Official

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