Healthcare Provider Details

I. General information

NPI: 1396142964
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 AIRTECH PKWY STE 106A
PLAINFIELD IN
46168-7456
US

IV. Provider business mailing address

3988 SOLUTIONS CTR
CHICAGO IL
60677-3009
US

V. Phone/Fax

Practice location:
  • Phone: 317-963-7100
  • Fax: 317-963-7110
Mailing address:
  • Phone: 317-963-9730
  • Fax: 317-963-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number60006420A
License Number StateIN

VII. Legacy identifiers

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

# 1
Identifier201272230A
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 2
Identifier2149229
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: PATRICK SORGEN
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 317-948-1598