Basic Information
| Provider Information | |||||||||
| NPI: | 1114247020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC. | ||||||||
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| OtherOrganizationName: | IU HEALTH BALL MEMORIAL PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | ATTN: CAROL BOYD | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179630413 | ||||||||
| FaxNumber: | 3179624343 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 S HUTCHINSON AVE | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473034774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652816920 | ||||||||
| FaxNumber: | 7652846151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 10/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | VANGETS | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7657513311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200986050 E | 05 | IN | MEDICAID | 207R00000X | 01 | IN | TAXONOMY | OTHER |