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General NPI Number Information
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NPI Number | 1730488818
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Entity Type | Organization
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Legal Business Name | JANE PAULEY COMMUNITY HEALTH CENTER INC
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 1503 N MITTHOEFFER RD STE 150
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-2425
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Country | US
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Telephone | 317-934-0755
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Fax | 317-469-1662
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Provider Business Mailing Address
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Address Line | 1503 N MITTHOEFFER RD STE 150
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-2425
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Country | US
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Telephone | 317-355-9320
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Fax | 317-355-9319
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Authorized Official
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Title or Position | CHIEF FINANCE OFFICER
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Name | MR. MICHAEL DALE
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Credential |
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Telephone | 317-934-0755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number State |
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Taxonomy #3
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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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