Healthcare Provider Details

I. General information

NPI: 1962772905
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR SUITE 1960
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

705 RILEY HOSPITAL DR SUITE 1960
INDIANAPOLIS IN
46202-5109
US

V. Phone/Fax

Practice location:
  • Phone: 317-374-8331
  • Fax: 317-944-3939
Mailing address:
  • Phone: 317-374-8331
  • Fax: 317-944-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number71003801A
License Number StateIN

VIII. Authorized Official

Name: MRS. JENNIFER ANN GROSSI
Title or Position: PEDIATRIC NURSE PRACTITIONER
Credential: CPNP
Phone: 317-374-8331