Healthcare Provider Details

I. General information

NPI: 1316764012
Provider Name (Legal Business Name): CAREATC - INDIANA PACKERS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 N US HIGHWAY 421
DELPHI IN
46923-8722
US

IV. Provider business mailing address

4500 S 129TH EAST AVE STE 191
TULSA OK
74134-5891
US

V. Phone/Fax

Practice location:
  • Phone: 765-564-2880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KELLY BENDER
Title or Position: SR. DIRECTOR, DATA & ANALYTICS
Credential:
Phone: 918-779-7475