MEDICARE: HEIDI KATE O'NEAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	175T00000X	Peer Specialist
3	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1649744210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI KATE O'NEAL

Provider Business Mailing Address
First Line	:	2105 N MERIDIAN ST STE 102
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1358
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 N MERIDIAN ST STE 102
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1358
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	01/17/2019

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