Healthcare Provider Details

I. General information

NPI: 1831448745
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF INDIANA ELKHART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S. THIRD ST., SUITE 160
ELKHART IN
46516
US

IV. Provider business mailing address

200 S. MERIDIAN ST. SUITE 400
INDIANAPOLIS IN
46225
US

V. Phone/Fax

Practice location:
  • Phone: 574-294-7561
  • Fax: 574-293-5479
Mailing address:
  • Phone: 317-637-4343
  • Fax: 317-637-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number01041899A
License Number StateIN

VIII. Authorized Official

Name: MS. SUZANNAH WILSON OVERHOLT
Title or Position: VICE PRESIDENT, FINANCE & ADMINISTR
Credential: J.D.
Phone: 317-637-4166