1174588099 NPI number — IU HEALTH ARNETT HOSPITAL, INC

Table of content: (NPI 1174588099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174588099 NPI number — IU HEALTH ARNETT HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IU HEALTH ARNETT 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:
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:
1174588099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47903-7301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-448-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1327 S 500 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-8718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-448-8000
Provider Business Practice Location Address Fax Number:
765-446-4619
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GATMAITAN
Authorized Official First Name:
ALFONSO
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
765-448-8000

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  10011506-1 , 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: 000000579846 . This is a "ANTHEM PROVIDER PIN FOR IU HEALTH ARNETT HOSPITAL, INC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200924720 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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