Provider Demographics
NPI:1720229198
Name:COMMUNITY HOSPITALS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA INC
Other - Org Name:COMMUNITY BREAST CARE
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 1:8040 CLEARVISTA PARKWAY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-5604
Mailing Address - Country:US
Mailing Address - Phone:317-621-7780
Mailing Address - Fax:317-621-7783
Practice Address - Street 1:8040 CLEARVISTA PARKWAY
Practice Address - Street 2:SUITE 290
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5604
Practice Address - Country:US
Practice Address - Phone:317-621-7780
Practice Address - Fax:317-621-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200934720Medicaid
IN260640Medicare PIN