=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932456928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLANNED PARENTHOOD OF INDIANA AVON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2012
-----------------------------------------------------
Last Update Date | 08/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8102 KINGSTON ST. SUITE 100
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46123-6909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-272-2042
-----------------------------------------------------
Fax | 317-272-0601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 S. MERIDIAN ST. SUITE 400
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-637-4343
-----------------------------------------------------
Fax | 317-637-4344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, FINANCE & ADMINISTRATION
-----------------------------------------------------
Name | SUZANNAH WILSON OVERHOLT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-637-4166
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0050X
-----------------------------------------------------
Taxonomy Name | Non-Surgical Family Planning Clinic/Center
-----------------------------------------------------
License Number | 01041899A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------