Healthcare Provider Details

I. General information

NPI: 1740410281
Provider Name (Legal Business Name): CITIZENS HEALTH / BARTON ANNEX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N EAST ST
INDIANAPOLIS IN
46204-1632
US

IV. Provider business mailing address

1650 N COLLEGE AVE
INDIANAPOLIS IN
46202-1715
US

V. Phone/Fax

Practice location:
  • Phone: 317-637-3449
  • Fax: 317-927-3098
Mailing address:
  • Phone: 317-924-6351
  • Fax: 317-927-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOLENE BURTRUM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD
Phone: 317-396-0280