Healthcare Provider Details

I. General information

NPI: 1982799896
Provider Name (Legal Business Name): COORDINATED HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 W. TIPTON ST. STE F
SEYMOUR IN
47274-2793
US

IV. Provider business mailing address

1171 W. TIPTON ST. STE F
SEYMOUR IN
47274-2793
US

V. Phone/Fax

Practice location:
  • Phone: 812-523-5864
  • Fax: 812-522-5835
Mailing address:
  • Phone: 812-523-5864
  • Fax: 812-522-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: WARREN FORGEY
Title or Position: VP/FISCAL CFO
Credential:
Phone: 812-523-5864