Organization
COMMUNITY HOSPITAL OF INDIANA INC
Active
Other names
Fortville Community Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERY KIRKHAM (CFO)
(317) 355-5822
Entity
Organization
Contact information
Practice address
717 E BROADWAY ST, FORTVILLE, IN 46040-1551
(317) 621-9220
(317) 621-9222
Mailing address
717 E BROADWAY ST, FORTVILLE, IN 46040-1551
(317) 621-9220
(317) 621-9222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200406960G
—
IN
Enumeration date
07/13/2006
Last updated
09/30/2009
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