Healthcare Provider Details

I. General information

NPI: 1124401856
Provider Name (Legal Business Name): ESKENAZI HEALTH FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 SHELBY ST
INDIANAPOLIS IN
46203-1945
US

IV. Provider business mailing address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5166
US

V. Phone/Fax

Practice location:
  • Phone: 317-655-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number12012361A
License Number StateIN

VIII. Authorized Official

Name: DR. JOHN KUNZER
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 317-880-8211