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
1	207V00000X	Obstetrics & Gynecology Physician
2	208000000X	Pediatrics Physician
3	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5942684	OTHER	IN	AETNA
3	000000226100	OTHER	IN	ANTHEM
4	000000107139	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1477626398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HOSPITALS OF INDIANA INC

Provider Business Mailing Address
First Line	:	3826 SOLUTIONS CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-3008
Country	:	US
Telephone Number	:	317-355-5837
Fax Number	:	317-355-2205

Provider Business Practice Location Address
First Line	:	2040 N SHADELAND AVE
Second Line	:	SUITE 300
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1711
Country	:	US
Telephone Number	:	317-355-3232
Fax Number	:	317-355-6042

Authorized Official
Title or Position	:	CFO
Name	:	JEFFERY KIRKHAM
Credential	:
Telephone Number	:	317-355-4887

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	10/13/2011

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1336565761 — SUSANA WILSON LCSW
Practice Location Address:

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Directions to “COMMUNITY HOSPITALS OF INDIANA INC ” Practice Location

Language	Start Address	Practice Location

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