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
1	122300000X	Dentist	100223780	IN
2	207Q00000X	Family Medicine Physician	200443050	IN
3	207R00000X	Internal Medicine Physician	200527220	IN
4	207V00000X	Obstetrics & Gynecology Physician	01023827A	IN
5	208000000X	Pediatrics Physician	200284500A	IN
6	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598776742
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	:	317-576-1339

Provider Business Practice Location Address
First Line	:	8003 CASTLEWAY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1946
Country	:	US
Telephone Number	:	317-576-1335
Fax Number	:	317-576-1339

Authorized Official
Title or Position	:	CFO
Name	:	TRACY NAGEL
Credential	:
Telephone Number	:	317-576-1335

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	11/10/2020

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Directions to “INDIANA HEALTH CENTERS, INC. ” Practice Location

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