Healthcare Provider Details

I. General information

NPI: 1134227689
Provider Name (Legal Business Name): INDIANA HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N CHESTNUT ST
SEYMOUR IN
47274-2176
US

IV. Provider business mailing address

113 N CHESTNUT ST
SEYMOUR IN
47274-2176
US

V. Phone/Fax

Practice location:
  • Phone: 812-524-8388
  • Fax: 812-524-8330
Mailing address:
  • Phone: 812-524-8388
  • Fax: 812-524-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRANCE J. DRAKE
Title or Position: CHIEF MEDICAL OFFICER (CMO)
Credential: M.D., F.A.A.P.
Phone: 317-576-1335