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General NPI Number Information
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NPI Number | 1457396541
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PEDIATRIC ASSOCIATES, INC.
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 705 RILEY HOSPITAL DR RR 127
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5109
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Country | US
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Telephone | 317-777-6435
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Fax | 317-777-6644
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Provider Business Mailing Address
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Address Line | PO BOX 778912
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City | CHICAGO
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State | IL
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Zip | 60677-8912
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Country | US
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Telephone | 317-777-6435
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Fax | 317-777-6644
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Authorized Official
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Title or Position | SECRETARY - TREASURER
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Name | LAURA S HANELINE
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Credential | MD
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Telephone | 317-777-6435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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