Provider Demographics
NPI:1063465946
Name:COMMUNITY HOSPITAL OF INDIANA, INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL OF INDIANA, INC
Other - Org Name:MEDCHECK CASTLETON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-355-5822
Mailing Address - Street 1:8177 CLEARVISTA PKWY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1662
Mailing Address - Country:US
Mailing Address - Phone:317-621-7801
Mailing Address - Fax:317-621-7205
Practice Address - Street 1:8177 CLEARVISTA PKWY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1662
Practice Address - Country:US
Practice Address - Phone:317-621-7801
Practice Address - Fax:317-621-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN827950Medicare PIN