Community Hospital of Indiana Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COMMUNITY HOSPITAL OF INDIANA INC

Doing business as

Fortville Community Medicine

Practice address

717 E Broadway St
Fortville, IN 46040-1551

Phone

(317) 621-9220

Fax

(317) 621-9222

NPI assigned

Jul 13, 2006

Last updated

Sep 30, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffery Kirkham

Title

Cfo

Phone

(317) 355-5822

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fortville Community Medicine Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1255356549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 E BROADWAY ST",
            "city": "FORTVILLE",
            "state": "IN",
            "postal_code": "460401551",
            "telephone_number": "317-621-9220",
            "fax_number": "317-621-9222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 E BROADWAY ST",
            "city": "FORTVILLE",
            "state": "IN",
            "postal_code": "460401551",
            "telephone_number": "317-621-9220",
            "fax_number": "317-621-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL OF INDIANA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "KIRKHAM",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-355-5822"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200406960G",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fortville Community Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Fortville, IN
• Providers in Fortville, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.