Healthcare Provider Details

I. General information

NPI: 1659716017
Provider Name (Legal Business Name): INDIANA UNIVERSITY SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N SENATE AVE
INDIANAPOLIS IN
46202-2213
US

IV. Provider business mailing address

1655 LEXINGTON RD
DANVILLE KY
40422-9795
US

V. Phone/Fax

Practice location:
  • Phone: 859-559-2341
  • Fax:
Mailing address:
  • Phone: 859-559-2341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LORA A GOUDREAU
Title or Position: RESIDENCY COORDINATOR
Credential:
Phone: 317-962-5423