Provider Demographics
NPI:1235109778
Name:COMMUNITY HOSPITAL SOUTH, INC.
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL SOUTH, INC.
Other - Org Name:COMMUNITY HOSPITAL SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-355-5860
Mailing Address - Street 1:6233 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0062
Mailing Address - Country:US
Mailing Address - Phone:317-355-1411
Mailing Address - Fax:317-351-7862
Practice Address - Street 1:1402 E COUNTY LINE ROAD S
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-9611
Practice Address - Country:US
Practice Address - Phone:317-887-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN005109282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270500AMedicaid
IN15-0128Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER