# COMMUNITY HOSPITAL OF INDIANA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fortville Community Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255356549
- **Authorized official:** JEFFERY KIRKHAM (CFO)
- **Authorized official phone:** (317) 355-5822

## Contact information

- **Practice address:** 717 E BROADWAY ST, FORTVILLE, IN 46040-1551
- **Practice address phone:** (317) 621-9220
- **Practice address fax:** (317) 621-9222
- **Mailing address:** 717 E BROADWAY ST, FORTVILLE, IN 46040-1551
- **Mailing address phone:** (317) 621-9220
- **Mailing address fax:** (317) 621-9222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2006
- **Last updated:** 09/30/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200406960G | — | IN |