Provider Demographics
NPI:1235871724
Name:COMMUNITY PHYSICIANS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY PHYSICIANS OF INDIANA INC
Other - Org Name:CITY OF FISHERS WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-497-6169
Mailing Address - Street 1:11787 LANTERN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2801
Mailing Address - Country:US
Mailing Address - Phone:317-957-9140
Mailing Address - Fax:317-957-9141
Practice Address - Street 1:11787 LANTERN RD STE 200
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2801
Practice Address - Country:US
Practice Address - Phone:317-957-9140
Practice Address - Fax:317-957-9141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY PHYSICIANS OF INDIANA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-13
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty