Healthcare Provider Details

I. General information

NPI: 1093819054
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PILGRIM BLVD
HARTFORD CITY IN
47348-1382
US

IV. Provider business mailing address

7001 SOLUTIONS CTR
CHICAGO IL
60677-3009
US

V. Phone/Fax

Practice location:
  • Phone: 765-348-4989
  • Fax: 765-348-8349
Mailing address:
  • Phone: 317-962-1522
  • Fax: 317-963-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60005866A
License Number StateIN

VIII. Authorized Official

Name: LORI LUTHER
Title or Position: CFO
Credential:
Phone: 765-751-2795