Healthcare Provider Details

I. General information

NPI: 1780068288
Provider Name (Legal Business Name): ASPIRE INDIANA HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 BROWN ST
ANDERSON IN
46016-4216
US

IV. Provider business mailing address

697 PRO MED LN
CARMEL IN
46032-5323
US

V. Phone/Fax

Practice location:
  • Phone: 317-574-1254
  • Fax: 317-674-0060
Mailing address:
  • Phone: 317-574-1254
  • Fax: 317-674-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY D CROCKETT
Title or Position: FINANCIAL OFFICER
Credential:
Phone: 317-587-0505