Healthcare Provider Details

I. General information

NPI: 1568492916
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH NORTH HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 N MERIDIAN ST ATTENTION - RANDALL YUST
CARMEL IN
46032-4656
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-2000
  • Fax:
Mailing address:
  • Phone: 317-962-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number050041711
License Number StateIN

VIII. Authorized Official

Name: KENNETHI D. PUCKETT
Title or Position: PRESIDENT
Credential:
Phone: 317-688-2077