Basic Information
| Provider Information | |||||||||
| NPI: | 1740391242 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HOSPITALS OF INDIANA INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | R KELLY CHAMBERS MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 MEDICAL ARTS BLVD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652985280 | ||||||||
| FaxNumber: | 7652985279 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 MEDICAL ARTS BLVD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652985280 | ||||||||
| FaxNumber: | 7652985279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 05/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | KIRKHAM | ||||||||
| AuthorizedOfficialFirstName: | JEFFERY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3173555822 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200406960N | 05 | IN | MEDICAID | DF7707 | 01 | IN | RR MEDICARE | OTHER |