1134227689 NPI number — INDIANA HEALTH CENTERS, INC.

Table of content: (NPI 1134227689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134227689 NPI number — INDIANA HEALTH CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA HEALTH CENTERS, 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:
COMMUNITY HEALTH CENTER OF JACKSON COUNTY
Provider Other Organization Name Type Code:
5
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:
1134227689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 N CHESTNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEYMOUR
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47274-2176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-524-8388
Provider Business Mailing Address Fax Number:
812-524-8330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 N CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEYMOUR
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47274-2176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-524-8388
Provider Business Practice Location Address Fax Number:
812-524-8330
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DRAKE
Authorized Official First Name:
TERRANCE
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER (CMO)
Authorized Official Telephone Number:
317-576-1335

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100071250 I , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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