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General NPI Number Information
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NPI Number | 1285946442
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Entity Type | Organization
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Legal Business Name | INDIANA CLINIC
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Dates
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Enumeration Date | 07/05/2010
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Last Update Date | 07/05/2010
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Provider Practice Location Address
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Address Line | 1701 N SENATE BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1239
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Country | US
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Telephone | 317-962-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 3724 SALEM ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4302
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Country | US
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Telephone | 317-507-9933
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MS. DONNA LYNN COLLINS
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Credential | MSW, LSW
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Telephone | 317-507-9933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 33004402A
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License Number State | IN
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