Healthcare Provider Details

I. General information

NPI: 1568743623
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N JORDAN AVE
BLOOMINGTON IN
47405-3190
US

IV. Provider business mailing address

600 N JORDAN AVE
BLOOMINGTON IN
47405-3190
US

V. Phone/Fax

Practice location:
  • Phone: 812-855-6511
  • Fax: 812-855-4628
Mailing address:
  • Phone: 812-855-6511
  • Fax: 812-855-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HUGH J JESSOP
Title or Position: EXECUTIVE DIRECTOR
Credential: HSD
Phone: 812-855-6511