Provider Demographics
NPI:1346261971
Name:COMMUNITY HOSPITALS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA INC
Other - Org Name:PENDLETON MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-355-5822
Mailing Address - Street 1:1251 HUNTZINGER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-9493
Mailing Address - Country:US
Mailing Address - Phone:765-298-4567
Mailing Address - Fax:765-298-4567
Practice Address - Street 1:1251 HUNTZINGER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-9493
Practice Address - Country:US
Practice Address - Phone:765-298-4567
Practice Address - Fax:765-298-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDC6886OtherRR MEDICARE
IN200849300AMedicaid
INDC6886OtherRR MEDICARE