1093819054 NPI number — INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093819054 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 BLACKFORD 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:
1093819054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7001 SOLUTIONS CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-3009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-962-1522
Provider Business Mailing Address Fax Number:
317-963-5003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 PILGRIM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47348-1382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-348-4989
Provider Business Practice Location Address Fax Number:
765-348-8349
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:  60005866A , 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: 2122553 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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