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General NPI Number Information
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NPI Number | 1306147236
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH NETWORK
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 524 N FAIRVIEW ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3774
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Country | US
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Telephone | 812-330-7837
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Fax |
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Provider Business Mailing Address
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Address Line | 524 N. FAIRVIEW ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-0000
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Country | US
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Telephone | 812-330-7837
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JEFFERY KIRKHAM
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Credential |
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Telephone | 317-355-5822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10-0050681
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License Number State | IN
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