MEDICARE: CARDINAL HEALTH PARTNERS, LLC

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	207Q00000X	Family Medicine Physician

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	:	1396776639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL HEALTH PARTNERS, LLC

Provider Business Mailing Address
First Line	:	5501 W BETHEL AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-8513
Country	:	US
Telephone Number	:	765-747-2950
Fax Number	:	765-747-2995

Provider Business Practice Location Address
First Line	:	5501 W BETHEL AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-8513
Country	:	US
Telephone Number	:	765-747-2950
Fax Number	:	765-747-2995

Authorized Official
Title or Position	:	COO PHYSICIAN NETWORK SERVICES
Name	:	JAN VANGETS
Credential	:
Telephone Number	:	765-751-3311

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/18/2008

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