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DSH150074AD COMMUNITY HOSPITALS OF INDIANA, INC. (Terminated)
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Main Details
Name
COMMUNITY HOSPITALS OF INDIANA, INC.
Subdivision Name
Sleep Lab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150074AD
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
David Cruse, Pharmacy Director
(317) 355-5106
Addresses
Street Address
7250 Clearvista Drive Suite 350
Indianapolis, IN 46256
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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