Healthcare Provider Details

I. General information

NPI: 1235150418
Provider Name (Legal Business Name): RENAISSANCE SPECIALTY HOSPITAL OF CENTRAL INDIANA OPERATIONS CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 UNIVERSITY AVE 8TH FLOOR NORTH TOWER
MUNCIE IN
47303-3428
US

IV. Provider business mailing address

2401 UNIVERSITY AVE 8TH FLOOR NORTH TOWER
MUNCIE IN
47303-3428
US

V. Phone/Fax

Practice location:
  • Phone: 765-282-5822
  • Fax: 765-289-5170
Mailing address:
  • Phone: 765-282-5822
  • Fax: 765-289-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN M. OTT
Title or Position: COO - CHIEF OPERATION OFFICER
Credential:
Phone: 765-282-8775