Healthcare Provider Details

I. General information

NPI: 1174824908
Provider Name (Legal Business Name): HIS SOLUTIONS HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W 8TH ST
ANDERSON IN
46016-1206
US

IV. Provider business mailing address

720 W 8TH ST
ANDERSON IN
46016-1206
US

V. Phone/Fax

Practice location:
  • Phone: 765-393-3457
  • Fax: 765-393-3458
Mailing address:
  • Phone: 765-393-3457
  • Fax: 765-393-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: MS. WENDY L SHANNON
Title or Position: CEO
Credential: NP
Phone: 765-393-3457