1679893580 NPI number — INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.

Table of content: (NPI 1679893580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679893580 NPI number — INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, 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:
1679893580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 N SHADELAND AVE
Provider Second Line Business Mailing Address:
ATTN: CAROL BOYD
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46219-4959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-963-0413
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 N TILLOTSON AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47304-3990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-751-3173
Provider Business Practice Location Address Fax Number:
765-213-2592
Provider Enumeration Date:
06/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VANGETS
Authorized Official First Name:
JANET
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR/OFFICER
Authorized Official Telephone Number:
765-751-5404

Provider Taxonomy Codes

  • Taxonomy code: 2080P0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200986050 D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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