Provider Demographics
NPI:1740391242
Name:COMMUNITY HOSPITALS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA INC
Other - Org Name:R KELLY CHAMBERS MD
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 1:1601 MEDICAL ARTS BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-3459
Mailing Address - Country:US
Mailing Address - Phone:765-298-5280
Mailing Address - Fax:765-298-5279
Practice Address - Street 1:1601 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3459
Practice Address - Country:US
Practice Address - Phone:765-298-5280
Practice Address - Fax:765-298-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200406960NMedicaid
INDF7707OtherRR MEDICARE
IN200406960NMedicaid
IN247430Medicare PIN