=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598085409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2010
-----------------------------------------------------
Last Update Date | 11/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 349 W 1ST ST
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47320-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-789-4545
-----------------------------------------------------
Fax | 765-789-4131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 N CELIA AVE ATTN: DEBERA BARKER
-----------------------------------------------------
City | MUNCIE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47303-4609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-282-8905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/OFFICER
-----------------------------------------------------
Name | JANET L VANGETS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 765-751-3311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------