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General NPI Number Information
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NPI Number | 1619072493
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Entity Type | Organization
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Legal Business Name | FAIRBANKS HOSPITAL, INC.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 8102 CLEARVISTA PKWY
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-1661
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Country | US
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Telephone | 317-849-8222
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Fax | 317-849-1455
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Provider Business Mailing Address
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Address Line | 8102 CLEARVISTA PKWY
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-1661
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Country | US
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Telephone | 317-849-8222
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Fax | 317-849-1455
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Authorized Official
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Title or Position | EVP FINANCE
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Name | HOLLY A MILLARD
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Credential |
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Telephone | 317-355-5860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (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 | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 835-1-P1P
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License Number State | IN
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