1982693743 NPI number — INDIANA UNIVERSITY

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 1982693743 NPI number — INDIANA UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY
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 SPEECH AND HEARING CLINICS
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:
1982693743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2631 EAST DISCOVERY PARKWAY
Provider Second Line Business Mailing Address:
HEALTH SCIENCES BUILDING
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47408-9059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-855-4156
Provider Business Mailing Address Fax Number:
812-855-5531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S JORDAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47405-7002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-855-4156
Provider Business Practice Location Address Fax Number:
812-855-5531
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HUMPHRESS
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
FISCAL OFFICER
Authorized Official Telephone Number:
812-855-4156

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100276980A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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