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General NPI Number Information
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NPI Number | 1417409186
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Entity Type | Organization
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Legal Business Name | INDIANA HEALTHCARE PHYSICIAN SERVICES, INC
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 640 KOLTER DR
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City | INDIANA
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State | PA
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Zip | 15701-3570
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Country | US
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Telephone | 724-357-7196
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Fax | 724-357-7279
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Provider Business Mailing Address
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Address Line | 640 KOLTER DR
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City | INDIANA
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State | PA
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Zip | 15701-3570
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Country | US
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Telephone | 724-357-7196
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Fax | 724-357-7279
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Authorized Official
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Title or Position | C.O.O.
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Name | BRETT J BRETT
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Credential |
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Telephone | 724-357-8230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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