Basic Information
| Provider Information | |||||||||
| NPI: | 1790979748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HOSPITALS OF INDIANA, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SYMPTOM MANAGEMENT GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7229 CLEARVISTA DR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462561698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176214300 | ||||||||
| FaxNumber: | 3176214366 | ||||||||
| Practice Location | |||||||||
| Address1: | 7229 CLEARVISTA DR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462561698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176214300 | ||||||||
| FaxNumber: | 3176214366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 02/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | FISCHER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3176214887 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0802X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 000000538640 | 01 | IN | ANTHEM | OTHER |