Provider Demographics
NPI:1164485710
Name:INDIANA HOSPITALISTS, PC
Entity Type:Organization
Organization Name:INDIANA HOSPITALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TALBOT
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:678-441-8500
Mailing Address - Street 1:5901-C PEACHTREE-DUNWOODY ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-7159
Mailing Address - Country:US
Mailing Address - Phone:678-441-8508
Mailing Address - Fax:678-441-8656
Practice Address - Street 1:1100 REID PARKWAY
Practice Address - Street 2:REID HOSPITAL
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-983-3492
Practice Address - Fax:678-441-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2908572Medicaid
DC9640OtherRAILROAD MEDICARE
IN200509560AMedicaid
IN200509560AMedicaid