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DSH150074V COMMUNITY HOSPITALS OF INDIANA, INC. (Terminated)
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Main Details
Name
COMMUNITY HOSPITALS OF INDIANA, INC.
Subdivision Name
Community Breast Care North
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150074V
Medicare Provider Number
150074
Outpatient Facility Provider Number
150074
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/29/2014
Last Recertification Date
8/20/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Community Hospital Indianapolis Region
David Kiley, President
(317) 621-9337
Primary Contact
Community East Hospital
Scott L. Teffeteller, President, East Region
(317) 355-3390
Addresses
Street Address
8040 Clearvista Parkway STE 290
Indianapolis, IN 46256
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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