Provider Demographics
NPI:1992909105
Name:COMMUNITY HOSPITALS OF INDIANA INC
Entity type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-355-5822
Mailing Address - Street 1:7150 CLEARVISTA DRIVE
Mailing Address - Street 2:CHN PEDIATRIC UNIT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1695
Mailing Address - Country:US
Mailing Address - Phone:317-621-9536
Mailing Address - Fax:317-621-9535
Practice Address - Street 1:7150 CLEARVISTA DRIVE
Practice Address - Street 2:CHN PEDIATRIC UNIT
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1695
Practice Address - Country:US
Practice Address - Phone:317-621-9536
Practice Address - Fax:317-621-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9620052OtherAETNA
IN200862130AMedicaid
IN000000523590OtherANTHEM
IN251460Medicare PIN