MEDICARE: COMMUNITY HOSPITALS OF INDIANA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA7844	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477506731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HOSPITALS OF INDIANA INC

Provider Business Mailing Address
First Line	:	1095 BROAD RIPPLE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2034
Country	:	US
Telephone Number	:	317-621-3731
Fax Number	:	317-621-4037

Provider Business Practice Location Address
First Line	:	1095 BROAD RIPPLE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2034
Country	:	US
Telephone Number	:	317-621-3731
Fax Number	:	317-621-4037

Authorized Official
Title or Position	:	CFO
Name	:	JEFFERY KIRKHAM
Credential	:
Telephone Number	:	317-355-5822

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	09/12/2009

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Directions to “COMMUNITY HOSPITALS OF INDIANA INC ” Practice Location

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