Healthcare Provider Details

I. General information

NPI: 1841710928
Provider Name (Legal Business Name): INDIANA NEIGHBORHOOD HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9613 E US HIGHWAY 36
AVON IN
46123-7978
US

IV. Provider business mailing address

250 WEST 96TH STREET SUITE 400
INDIANAPOLIS IN
46260-1316
US

V. Phone/Fax

Practice location:
  • Phone: 317-613-5300
  • Fax: 317-338-6960
Mailing address:
  • Phone: 317-338-2432
  • Fax: 317-338-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD FOGEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-338-7074