Healthcare Provider Details

I. General information

NPI: 1356396295
Provider Name (Legal Business Name): INDIANA HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 PRO-MED LN
CARMEL IN
46032-5317
US

IV. Provider business mailing address

703 PRO-MED LN
CARMEL IN
46032-5317
US

V. Phone/Fax

Practice location:
  • Phone: 317-843-9922
  • Fax: 317-843-4980
Mailing address:
  • Phone: 317-843-9922
  • Fax: 317-843-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateIN

VIII. Authorized Official

Name: GREGORY SIPES
Title or Position: PARTNER
Credential: PHD
Phone: 317-843-9922