MEDICARE: INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	60005866A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2122553	OTHER		PK

General Provider Information

NPI Number	:	1093819054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC

Provider Business Mailing Address
First Line	:	7001 SOLUTIONS CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-3009
Country	:	US
Telephone Number	:	317-962-1522
Fax Number	:	317-963-5003

Provider Business Practice Location Address
First Line	:	400 PILGRIM BLVD
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-1382
Country	:	US
Telephone Number	:	765-348-4989
Fax Number	:	765-348-8349

Authorized Official
Title or Position	:	CFO
Name	:	LORI LUTHER
Credential	:
Telephone Number	:	765-751-2795

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	08/18/2016

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