Healthcare Provider Details

I. General information

NPI: 1740527373
Provider Name (Legal Business Name): FRANCISCAN HEALTH LAFAYETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 UNITY PL
LAFAYETTE IN
47905-5756
US

IV. Provider business mailing address

PO BOX 781019
DETROIT MI
48278-1019
US

V. Phone/Fax

Practice location:
  • Phone: 765-447-7460
  • Fax: 765-447-8396
Mailing address:
  • Phone: 765-502-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number StateIN

VIII. Authorized Official

Name: TERRANCE E WILSON
Title or Position: CEO
Credential:
Phone: 765-502-4000