MEDICARE: STATE OF INDIANA AUDITOR OF STATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	140011341	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194778001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF INDIANA AUDITOR OF STATE

Provider Business Mailing Address
First Line	:	3851 N RIVER RD
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-3765
Country	:	US
Telephone Number	:	765-463-1502
Fax Number	:	765-497-8001

Provider Business Practice Location Address
First Line	:	3851 N RIVER RD
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-3765
Country	:	US
Telephone Number	:	765-463-1502
Fax Number	:	765-497-8001

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	LINDA SHARP
Credential	:
Telephone Number	:	765-463-1502

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	02/28/2014

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Directions to “STATE OF INDIANA AUDITOR OF STATE ” Practice Location

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