Healthcare Provider Details

I. General information

NPI: 1578205548
Provider Name (Legal Business Name): INDIANA HOME BASED PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11595 N MERIDIAN ST STE 515
CARMEL IN
46032-6969
US

IV. Provider business mailing address

805 N WHITTINGTON PKWY STE 400
LOUISVILLE KY
40222-7102
US

V. Phone/Fax

Practice location:
  • Phone: 800-807-6555
  • Fax: 855-316-2999
Mailing address:
  • Phone: 502-394-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ROBERT MILLS
Title or Position: PRESIDENT
Credential: MD
Phone: 502-394-2100