Provider Demographics
NPI:1013130533
Name:COMMUNITY HOSPITALS OF INDIANA INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA INC
Other - Org Name:COMMUNITY NEUROSURGERY
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:317-355-4887
Mailing Address - Street 1:1400 N RITTER AVE
Mailing Address - Street 2:SUITE 231
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3046
Mailing Address - Country:US
Mailing Address - Phone:317-355-1470
Mailing Address - Fax:317-355-1475
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:SUITE 231
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3046
Practice Address - Country:US
Practice Address - Phone:317-355-1470
Practice Address - Fax:317-355-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059582A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200818230Medicaid
IN9824143OtherAETNA
IN000000391403OtherANTHEM
IN000000391403OtherANTHEM
IN200818230Medicaid