Healthcare Provider Details

I. General information

NPI: 1659302883
Provider Name (Legal Business Name): CARDINAL HEALTH PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/18/2008
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

205 N TILLOTSON AVE
MUNCIE IN
47304-3900
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-1995
  • Fax: 765-281-9114
Mailing address:
  • Phone: 765-288-1995
  • Fax: 765-281-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAN VANGETS
Title or Position: COO PHYSICIAN NETWORK SERVICES
Credential:
Phone: 765-751-3311