Provider Demographics
NPI:1023222031
Name:HAMILTON COUNTY WIC PROGRAM
Entity Type:Organization
Organization Name:HAMILTON COUNTY WIC PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CLOTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-576-1335
Mailing Address - Street 1:INDIANA HEALTH CENTERS, INC.
Mailing Address - Street 2:8003 CASTLEWAY DRIVE
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250
Mailing Address - Country:US
Mailing Address - Phone:317-576-1335
Mailing Address - Fax:317-576-1339
Practice Address - Street 1:HAMILTON COUNTY WIC PROGRAM
Practice Address - Street 2:942 NORTH TENTH STREET
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060
Practice Address - Country:US
Practice Address - Phone:317-776-3445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare