Healthcare Provider Details

I. General information

NPI: 1972555357
Provider Name (Legal Business Name): UNITY HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CREASY LN
LAFAYETTE IN
47905-4960
US

IV. Provider business mailing address

PO BOX 4699
LAFAYETTE IN
47903-4699
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-5417
  • Fax: 765-446-5317
Mailing address:
  • Phone: 765-446-5417
  • Fax: 765-446-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number207L00000X
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number207LP2900X
License Number StateIN

VIII. Authorized Official

Name: MARTHA K MILLER
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 765-446-5286