MEDICARE: INJECT HEALTH, LLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1144708413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INJECT HEALTH, LLC

Provider Business Mailing Address
First Line	:	1221 S CREASY LN STE K3
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-7430
Country	:	US
Telephone Number	:	317-965-6515
Fax Number	:	317-559-5971

Provider Business Practice Location Address
First Line	:	1833 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2735
Country	:	US
Telephone Number	:	765-838-2310
Fax Number	:	317-559-5971

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SUSAN ROBERTSON
Credential	:
Telephone Number	:	317-965-6515

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	07/30/2018

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