Healthcare Provider Details

I. General information

NPI: 1700113792
Provider Name (Legal Business Name): HENDRICKS REGIONAL HEALTH OCCUPATIONAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SOUTHFIELD DR SUITE 1120
PLAINFIELD IN
46168-4498
US

IV. Provider business mailing address

1100 SOUTHFIELD DR SUITE 1120
PLAINFIELD IN
46168-4498
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-7200
  • Fax: 317-837-7926
Mailing address:
  • Phone: 317-839-7200
  • Fax: 317-837-7926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DENNIS W DAWES
Title or Position: CEO/PRESIDENT
Credential:
Phone: 317-745-4451