1710983945 NPI number — INDIANA UNIVERSITY HEALTH WHITE MEMORIAL HOSPITAL INC

Table of content: (NPI 1710983945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710983945 NPI number — INDIANA UNIVERSITY HEALTH WHITE MEMORIAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY HEALTH WHITE 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:
Provider Other Organization Name Type Code:
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:
1710983945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 N MERIDIAN ST STE 1200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46204-1011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-962-1093
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 S 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47960-8182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-583-7111
Provider Business Practice Location Address Fax Number:
574-583-1703
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MINIER
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
574-583-1757

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  050050341 , 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: 351140233001 . This is a "TRICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100270480A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000097808 . This is a "BLUE CROSS HOSPITAL" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100270490A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023523100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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