Healthcare Provider Details

I. General information

NPI: 1407194426
Provider Name (Legal Business Name): COMMUNITY PHYSICIANS OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18051 RIVER AVENUE SUITE 100
NOBLESVILLE IN
46062-7093
US

IV. Provider business mailing address

18051 RIVER AVENUE SUITE 100
NOBLESVILLE IN
46062-7093
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-6980
  • Fax: 317-621-3090
Mailing address:
  • Phone: 317-621-6980
  • Fax: 317-621-3090

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: PATRICK E RANKIN
Title or Position: CMO
Credential: MD
Phone: 317-621-1659