Provider Demographics
NPI:1669483392
Name:COMMUNITY HOSPITALS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA INC
Other - Org Name:BRILLHART OB GYN
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 1:13121 OLIO RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7239
Mailing Address - Country:US
Mailing Address - Phone:317-621-2400
Mailing Address - Fax:317-621-5266
Practice Address - Street 1:13121 OLIO RD
Practice Address - Street 2:SUITE 220
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7239
Practice Address - Country:US
Practice Address - Phone:317-621-2400
Practice Address - Fax:317-621-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200485910AMedicaid
IN216810Medicare PIN