Healthcare Provider Details

I. General information

NPI: 1073639936
Provider Name (Legal Business Name): HENDRICKS REGIONAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN STREET
DANVILLE IN
46122-1948
US

IV. Provider business mailing address

1000 E MAIN STREET
DANVILLE IN
46122-1948
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-9531
  • Fax: 317-745-9534
Mailing address:
  • Phone: 317-745-9531
  • Fax: 317-745-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number101037731A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1255404455/71002313A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number72000117B/72000005B
License Number StateIN

VIII. Authorized Official

Name: DENNIS W. DAWES
Title or Position: PRESIDENT/CEO OF HENDRICKS REGIONAL
Credential:
Phone: 317-745-9530