Provider Demographics
NPI:1093819054
Name:INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC
Other - Org Name:IU HEALTH BLACKFORD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-751-2795
Mailing Address - Street 1:7001 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-3009
Mailing Address - Country:US
Mailing Address - Phone:317-962-1522
Mailing Address - Fax:317-963-5003
Practice Address - Street 1:400 PILGRIM BLVD
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-1382
Practice Address - Country:US
Practice Address - Phone:765-348-4989
Practice Address - Fax:765-348-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005866A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122553OtherPK
IN0797520005Medicare NSC
1560019OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IN200509130AMedicaid