Healthcare Provider Details

I. General information

NPI: 1770983199
Provider Name (Legal Business Name): INDIANA HEALTH SOLUTIONS II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 PENDLETON PIKE
INDIANAPOLIS IN
46236-2843
US

IV. Provider business mailing address

2809 TOWNE DR
CARMEL IN
46032-9751
US

V. Phone/Fax

Practice location:
  • Phone: 317-826-7425
  • Fax: 317-826-0744
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN STANTON
Title or Position: MEMBER
Credential:
Phone: 317-730-0525