Healthcare Provider Details

I. General information

NPI: 1821428855
Provider Name (Legal Business Name): INDIANA HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 N KEYSTONE AVE SUITE B
INDIANAPOLIS IN
46240-3374
US

IV. Provider business mailing address

2809 TOWNE DR
CARMEL IN
46032-9751
US

V. Phone/Fax

Practice location:
  • Phone: 317-259-4616
  • Fax:
Mailing address:
  • Phone: 317-730-0525
  • 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: BRIAN STANTON
Title or Position: MEMBER
Credential:
Phone: 317-259-4616