1902032832 NPI number — INDIANA UNIVERSITY HEALTH CARE ASSOCIATES, INC

Table of content: (NPI 1902032832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902032832 NPI number — INDIANA UNIVERSITY HEALTH CARE ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY HEALTH CARE ASSOCIATES, 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:
IU HEALTH PHYSICIANS
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:
1902032832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2024
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:
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:
888-484-3258
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 W TENTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-3082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-278-3505
Provider Business Practice Location Address Fax Number:
317-962-0861
Provider Enumeration Date:
06/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
TODD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
317-948-3525

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 201015830 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201034580 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201075140 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200967200 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201033600 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200976030 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012654000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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