=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427145630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2006
-----------------------------------------------------
Last Update Date | 08/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 WISHARD BOULEVARD
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-630-7020
-----------------------------------------------------
Fax | 317-630-7100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 ESKENAZI AVENUE FIFTH THIRD BANK BUILDING, 5TH FLOOR
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46202-5166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-880-3999
-----------------------------------------------------
Fax | 317-880-0343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | LEE LIVIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-630-7592
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number | 60005918A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------