Healthcare Provider Details

I. General information

NPI: 1801815832
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH WEST HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY BUILDING C
AVON IN
46123-7085
US

IV. Provider business mailing address

250 N SHADELAND AVE SUITE 200
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-3043
  • Fax:
Mailing address:
  • Phone: 317-962-4836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BAILEY
Title or Position: PRESIDENT, CEO
Credential:
Phone: 317-217-3043