Provider Demographics
NPI:1821015850
Name:COMMUNITY HOSPITALS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA INC
Other - Org Name:NORTHSIDE FAMILY 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 1:8202 CLEARVISTA PKWY
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1442
Mailing Address - Country:US
Mailing Address - Phone:317-579-1670
Mailing Address - Fax:317-579-1680
Practice Address - Street 1:8202 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 6B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1442
Practice Address - Country:US
Practice Address - Phone:317-579-1670
Practice Address - Fax:317-579-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200406960 PMedicaid
INDD2062OtherMEDICARE RAILROAD
IN200406960AMedicaid
IN215160Medicare PIN