=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356505382
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY HOSPITALS OF INDIANA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2008
-----------------------------------------------------
Last Update Date | 12/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8202 CLEARVISTA PKWY SUITE 8B
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46256-1456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-621-1510
-----------------------------------------------------
Fax | 317-621-1511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8202 CLEARVISTA PKWY SUITE 8B
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46256-1456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-621-1510
-----------------------------------------------------
Fax | 317-621-1511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | JEFFERY KIRKHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-355-5822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 02003353A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------