1669582664 NPI number — INDIANA HEALTH CENTERS, INC.

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 1669582664 NPI number — INDIANA HEALTH CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA HEALTH CENTERS, 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:
CASS COUNTY COMMUNITY HEALTH CENTER
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:
1669582664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8003 CASTLEWAY DR
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:
46250-1946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-576-1335
Provider Business Mailing Address Fax Number:
317-576-1339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 DIVIDEND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947-1572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-722-7407
Provider Business Practice Location Address Fax Number:
574-847-7203
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NAGEL
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
317-576-1335

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100071250 H , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com