Healthcare Provider Details

I. General information

NPI: 1164485710
Provider Name (Legal Business Name): INDIANA HOSPITALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 REID PARKWAY REID HOSPITAL
RICHMOND IN
47374-1157
US

IV. Provider business mailing address

5901-C PEACHTREE-DUNWOODY ROAD SUITE 350
ATLANTA GA
30328-7159
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3492
  • Fax: 678-441-8656
Mailing address:
  • Phone: 678-441-8508
  • Fax: 678-441-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: TALBOT GREEN MCCORMICK III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 678-441-8500