Provider Demographics
NPI:1043468176
Name:COMMUNITY HOSPITALS OF INDIANA, INC
Entity type:Organization
Organization Name:COMMUNITY HOSPITALS OF INDIANA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFEREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-355-5822
Mailing Address - Street 1:11590 N MERIDIAN ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6963
Mailing Address - Country:US
Mailing Address - Phone:317-621-2211
Mailing Address - Fax:317-621-2218
Practice Address - Street 1:11590 N MERIDIAN ST
Practice Address - Street 2:SUITE 170
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6963
Practice Address - Country:US
Practice Address - Phone:317-621-2211
Practice Address - Fax:317-621-2218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOSPITALS OF INDIANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-03
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200931580AMedicaid
IN200931580AMedicaid