1871825216 NPI number — HENDRICKS COMMUNITY HOSPITAL

Table of content: (NPI 1871825216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871825216 NPI number — HENDRICKS COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENDRICKS COMMUNITY HOSPITAL
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:
AVON COMMUNITY SCHOOLS WELLNESS CLINIC
Provider Other Organization Name Type Code:
3
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:
1871825216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8244 E US HIGHWAY 36
Provider Second Line Business Mailing Address:
STE. 1100
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46123-9575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-272-3688
Provider Business Mailing Address Fax Number:
317-272-7515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7203 E US HIGHWAY 36
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46123-7967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-544-6135
Provider Business Practice Location Address Fax Number:
317-544-6139
Provider Enumeration Date:
02/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DAWES
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
317-745-3500

Provider Taxonomy Codes

  • Taxonomy code: 261QC1800X , with the licence number:  09005005 , 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)





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