Provider Demographics
NPI:1821015629
Name:COMMUNITY HOSPITALS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA INC
Other - Org Name:PARKSIDE INTERNAL MEDICINE
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 1:13050 PARKSIDE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-8235
Mailing Address - Country:US
Mailing Address - Phone:317-588-2233
Mailing Address - Fax:317-588-2244
Practice Address - Street 1:13050 PARKSIDE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-8235
Practice Address - Country:US
Practice Address - Phone:317-588-2233
Practice Address - Fax:317-588-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200325490TMedicaid
INDB0195OtherMEDICARE RAILROAD
INDB0195OtherMEDICARE RAILROAD