Healthcare Provider Details

I. General information

NPI: 1396765731
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH NORTH HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 N ILLINOIS ST
CARMEL IN
46032-3008
US

IV. Provider business mailing address

250 N SHADELAND AVE SUITE 130
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-4836
  • Fax: 317-962-4391
Mailing address:
  • Phone: 317-962-4836
  • Fax: 317-962-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: JONATHAN R GOBLE
Title or Position: PRESIDENT, CEO
Credential:
Phone: 317-962-4836