Basic Information
| Provider Information | |||||||||
| NPI: | 1245578269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY PHYSICIANS OF INDIANA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14540 PRAIRIE LAKES BLVD NORTH | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460604370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176210370 | ||||||||
| FaxNumber: | 3176210383 | ||||||||
| Practice Location | |||||||||
| Address1: | 14540 PRAIRIE LAKES BLVD NORTH | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460604370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176210370 | ||||||||
| FaxNumber: | 3176210383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2013 | ||||||||
| LastUpdateDate: | 11/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | RANKIN | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CMO | ||||||||
| AuthorizedOfficialTelephone: | 3176211659 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 201168260F | 05 | IN | MEDICAID |