Healthcare Provider Details

I. General information

NPI: 1104195098
Provider Name (Legal Business Name): HENDRICKS COUNTY WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 E MAIN ST
DANVILLE IN
46122-1934
US

IV. Provider business mailing address

8244 E US HIGHWAY 36 SUITE 1100
AVON IN
46123-9575
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-2950
  • Fax: 317-718-2955
Mailing address:
  • Phone: 317-272-7500
  • Fax: 317-272-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER RUTHERFORD
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 317-837-5566