Healthcare Provider Details

I. General information

NPI: 1518236389
Provider Name (Legal Business Name): WISHARD HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

1001 W 10TH ST
INDIANAPOLIS IN
46202-2859
US

V. Phone/Fax

Practice location:
  • Phone: 317-630-7233
  • Fax: 317-656-4202
Mailing address:
  • Phone: 317-630-7233
  • Fax: 317-656-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number28108310A
License Number StateIN

VIII. Authorized Official

Name: MRS. REBECCA NAVARRO
Title or Position: PROGRAM CO-ORDINATOR
Credential:
Phone: 317-630-7646