1093023046 NPI number — INDIANA CENTER FOR ADVANCED MEDICINE

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 1093023046 NPI number — INDIANA CENTER FOR ADVANCED MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA CENTER FOR ADVANCED MEDICINE
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:
6
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:
1093023046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8330 NAAB RD
Provider Second Line Business Mailing Address:
SUITE 235
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-5925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-228-9270
Provider Business Mailing Address Fax Number:
317-228-9275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8330 NAAB RD
Provider Second Line Business Practice Location Address:
SUITE 235
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46260-5925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-228-9270
Provider Business Practice Location Address Fax Number:
317-228-9275
Provider Enumeration Date:
09/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VERA URBINA
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
317-228-9270

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  01047322A , 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: 01047322A . This is a "STATE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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