Healthcare Provider Details

I. General information

NPI: 1699094870
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 S MAIN ST
UPLAND IN
46989-9242
US

IV. Provider business mailing address

221 N CELIA AVE ATTN: DEBERA BARKER
MUNCIE IN
47303-4609
US

V. Phone/Fax

Practice location:
  • Phone: 765-992-6200
  • Fax: 765-998-6204
Mailing address:
  • Phone: 765-282-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET L VANGETS
Title or Position: DIRECTOR/OFFICER
Credential:
Phone: 765-751-5404