Healthcare Provider Details

I. General information

NPI: 1568842490
Provider Name (Legal Business Name): ESKENAZI HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/05/2015
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

163 N 500 W
ANDERSON IN
46011-1434
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-0000
  • Fax:
Mailing address:
  • Phone: 765-208-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ESTA OTT
Title or Position: CREDENTIAL SPECIALIST
Credential:
Phone: 317-880-4104