Provider Demographics
NPI:1265817076
Name:COMMUNITY PHYSICIANS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY PHYSICIANS OF INDIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVORKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-621-1591
Mailing Address - Street 1:1030 E COUNTY LINE RD
Mailing Address - Street 2:SUITE B3
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2932
Mailing Address - Country:US
Mailing Address - Phone:317-497-6024
Mailing Address - Fax:317-497-2507
Practice Address - Street 1:1030 E COUNTY LINE RD
Practice Address - Street 2:SUITE B3
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2932
Practice Address - Country:US
Practice Address - Phone:317-497-6024
Practice Address - Fax:317-497-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6751500014Medicare NSC