Healthcare Provider Details

I. General information

NPI: 1578253233
Provider Name (Legal Business Name): HEALTH ASSOCIATES INDY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9240 N MERIDIAN ST STE 320
INDIANAPOLIS IN
46260-1822
US

IV. Provider business mailing address

9240 N MERIDIAN ST STE 320
INDIANAPOLIS IN
46260-1822
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-7489
  • Fax: 317-581-1007
Mailing address:
  • Phone: 317-844-7489
  • Fax: 317-581-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JERAD DALTON
Title or Position: MEMBER
Credential: DO
Phone: 317-844-7489