Healthcare Provider Details

I. General information

NPI: 1669622783
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 S. MERIDIAN ST SUITE 105
INDIANAPOLIS IN
46217-6057
US

IV. Provider business mailing address

1776 N MERIDIAN ST STE 100A RETAIL PHARMACY ADMIN
INDIANAPOLIS IN
46202-1468
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-6833
  • Fax: 317-865-6832
Mailing address:
  • Phone: 317-962-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60006255A
License Number StateIN

VIII. Authorized Official

Name: RYAN KITCHELL
Title or Position: EVP & CFO
Credential:
Phone: 317-962-2380