Provider Demographics
NPI:1750306338
Name:COMMUNITY HOSPITALS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA INC
Other - Org Name:COMMUNITY 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 1:1130 MEDICAL ARTS BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-3431
Mailing Address - Country:US
Mailing Address - Phone:765-298-4282
Mailing Address - Fax:317-298-4989
Practice Address - Street 1:1130 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3431
Practice Address - Country:US
Practice Address - Phone:765-298-4282
Practice Address - Fax:317-298-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDB4002OtherRR MEDICARE
IN200326750HMedicaid
IN200326750HMedicaid