Healthcare Provider Details

I. General information

NPI: 1710206990
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: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S PILGRIM BLVD
YORKTOWN IN
47396-9250
US

IV. Provider business mailing address

250 N SHADELAND AVE ATTN: CAROL BOYD
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-759-4068
  • Fax: 765-759-4075
Mailing address:
  • Phone: 317-963-0413
  • Fax:

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: JANET L VANGETS
Title or Position: DIRECTOR/OFFICER
Credential:
Phone: 765-751-3311