1679678197 NPI number — FRANCISCAN HEALTH INDIANAPOLIS & MOORESVILLE

Table of content: (NPI 1679678197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679678197 NPI number — FRANCISCAN HEALTH INDIANAPOLIS & MOORESVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANCISCAN HEALTH INDIANAPOLIS & MOORESVILLE
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:
FRANCISCAN HEALTH - MOORESVILLE
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:
1679678197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 781008
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48278-1008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-528-4800
Provider Business Mailing Address Fax Number:
317-865-1479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 HADLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46158-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-528-8953
Provider Business Practice Location Address Fax Number:
317-528-6696
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAUTER
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
317-528-8953

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 06-005052-1 , 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: 200859740A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 481838 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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