1457455404 NPI number — INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC

Table of content: (NPI 1457455404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457455404 NPI number — INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IU HEALTH FAMILY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457455404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1633 N CAPITOL AVE
Provider Second Line Business Mailing Address:
SUITE 438
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-1261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-963-9730
Provider Business Mailing Address Fax Number:
317-963-5003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5501 W BETHEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47304-8513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-751-7900
Provider Business Practice Location Address Fax Number:
765-747-2996
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUTHER
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
765-751-2795

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  60005307A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200185540 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1533707 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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