Healthcare Provider Details

I. General information

NPI: 1124348032
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N TILLOTSON AVE
MUNCIE IN
47304-3900
US

IV. Provider business mailing address

250 N SHADELAND AVE ATTN: CAROL BOYD
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-281-4599
  • Fax: 765-281-9114
Mailing address:
  • Phone: 317-963-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET L VANGETS
Title or Position: DIRECTOR/OFFICER
Credential:
Phone: 765-751-3311