Provider Demographics
NPI:1285019851
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 1:2312 S DIXON ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6423
Mailing Address - Country:US
Mailing Address - Phone:765-865-6633
Mailing Address - Fax:765-865-6634
Practice Address - Street 1:2312 S DIXON ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6423
Practice Address - Country:US
Practice Address - Phone:765-865-6633
Practice Address - Fax:765-865-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
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
IN6751500009Medicare NSC