Provider Demographics
NPI:1093023046
Name:INDIANA CENTER FOR ADVANCED MEDICINE
Entity Type:Organization
Organization Name:INDIANA CENTER FOR ADVANCED MEDICINE
Other - Org Name:INDIANA HEALTH AND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:VERA URBINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-228-9270
Mailing Address - Street 1:8330 NAAB RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5925
Mailing Address - Country:US
Mailing Address - Phone:317-228-9270
Mailing Address - Fax:317-228-9275
Practice Address - Street 1:8330 NAAB RD
Practice Address - Street 2:SUITE 235
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5925
Practice Address - Country:US
Practice Address - Phone:317-228-9270
Practice Address - Fax:317-228-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047322A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01047322AOtherSTATE