Healthcare Provider Details

I. General information

NPI: 1962433763
Provider Name (Legal Business Name): CARDINAL HEALTH PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 S MAIN ST
UPLAND IN
46989
US

IV. Provider business mailing address

PO BOX 690
UPLAND IN
46989-0690
US

V. Phone/Fax

Practice location:
  • Phone: 765-998-6200
  • Fax: 765-998-6204
Mailing address:
  • Phone: 765-998-6200
  • Fax: 765-998-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAN VANGETS
Title or Position: COO PHYSICIAN NETWORK SERVICES
Credential:
Phone: 765-751-3311