Provider Demographics
NPI:1225103518
Name:COMMUNITY HOSPITALS OF INDIANA
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA
Other - Org Name:LIFE'S JOURNEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-355-4887
Mailing Address - Street 1:PO BOX 19751
Mailing Address - Street 2:LOWER LEVEL PHYSICIAN BILLING
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-0751
Mailing Address - Country:US
Mailing Address - Phone:317-621-9536
Mailing Address - Fax:317-621-9535
Practice Address - Street 1:1500 N RITTER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3027
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:2006-11-21
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200805410AMedicaid
IN200805410BMedicaid
IN200805410CMedicaid
INDE2682OtherRAILROAD MEDICARE
IN200805410BMedicaid