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NPI Code Detail

MEDICARE: INDIANA HEALTH CENTERS, INC

MEDICARE: INDIANA HEALTH CENTERS, 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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1558629634
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDIANA HEALTH CENTERS, INC
Provider Business Mailing Address
First Line : 8003 CASTLEWAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-1946
Country : US
Telephone Number : 317-576-1335
Fax Number : 317-573-1339
Provider Business Practice Location Address
First Line : 1102 FELLOWS ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46601-3514
Country : US
Telephone Number : 574-234-9033
Fax Number : 574-234-9059
Authorized Official
Title or Position : CFO
Name : MR. TRACY J NAGEL
Credential :
Telephone Number : 317-576-1335
Provider Enumeration Date : 04/26/2012
Last Update Date : 04/26/2012

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Directions to “INDIANA HEALTH CENTERS, INC ” Practice Location

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