Provider Demographics
NPI:1669951471
Name:COMMUNITY HEALTH NETWORK, INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH NETWORK, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSMENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-355-4992
Mailing Address - Street 1:6233 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60682-0062
Mailing Address - Country:US
Mailing Address - Phone:317-355-4992
Mailing Address - Fax:
Practice Address - Street 1:7250 CLEARVISTA DR STE 140
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4640
Practice Address - Country:US
Practice Address - Phone:317-621-3100
Practice Address - Fax:317-621-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3000022457Medicaid