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General NPI Number Information
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NPI Number | 1649063249
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Entity Type | Organization
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Legal Business Name | INDIANA HEALTH CENTERS, INC
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 813 S MICHIGAN ST
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City | SOUTH BEND
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State | IN
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Zip | 46601-3102
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Country | US
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Telephone | 574-235-7990
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Fax | 574-847-7201
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Provider Business Mailing Address
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Address Line | 813 S MICHIGAN ST
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City | SOUTH BEND
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State | IN
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Zip | 46601-3102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | TRACY NAGEL
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Credential |
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Telephone | 317-576-1335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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