Healthcare Provider Details

I. General information

NPI: 1881943769
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF INDIANA MISHAWAKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 GRAPE RD. #B
MISHAWAKA IN
46545-2709
US

IV. Provider business mailing address

200 S. MERIDIAN ST. SUITE 400
INDIANAPOLIS IN
46225
US

V. Phone/Fax

Practice location:
  • Phone: 574-255-9555
  • Fax: 574-259-5761
Mailing address:
  • Phone: 317-637-4343
  • Fax: 317-637-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number01041899A
License Number StateIN

VIII. Authorized Official

Name: MS. SUZANNAH WILSON OVERHOLT
Title or Position: VICE PRESIDENT, FINANCE & ADMINISTR
Credential: J.D.
Phone: 317-637-4166