Healthcare Provider Details

I. General information

NPI: 1457455404
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 W BETHEL AVE
MUNCIE IN
47304-8513
US

IV. Provider business mailing address

1633 N CAPITOL AVE SUITE 438
INDIANAPOLIS IN
46202-1261
US

V. Phone/Fax

Practice location:
  • Phone: 765-751-7900
  • Fax: 765-747-2996
Mailing address:
  • Phone: 317-963-9730
  • Fax: 317-963-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60005307A
License Number StateIN

VIII. Authorized Official

Name: LORI LUTHER
Title or Position: CFO
Credential:
Phone: 765-751-2795