MEDICARE: INDIANA HOME BASED PRIMARY CARE PC

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	253Z00000X	In Home Supportive Care Agency
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1578205548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA HOME BASED PRIMARY CARE PC

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY STE 400
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7102
Country	:	US
Telephone Number	:	502-394-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	11595 N MERIDIAN ST STE 515
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-6969
Country	:	US
Telephone Number	:	800-807-6555
Fax Number	:	855-316-2999

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM ROBERT MILLS
Credential	:	MD
Telephone Number	:	502-394-2100

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	11/11/2025

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