Provider Demographics
NPI:1104195098
Name:HENDRICKS COUNTY WELLNESS CLINIC
Entity Type:Organization
Organization Name:HENDRICKS COUNTY WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR IMMEDIATE CARE
Authorized Official - Prefix:
Authorized Official - First Name:MARIJANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSN,NE-BC
Authorized Official - Phone:317-272-3688
Mailing Address - Street 1:8244 E US HIGHWAY 36
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9575
Mailing Address - Country:US
Mailing Address - Phone:317-272-7500
Mailing Address - Fax:317-272-7515
Practice Address - Street 1:998 E MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1971
Practice Address - Country:US
Practice Address - Phone:317-718-2950
Practice Address - Fax:317-718-2955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDRICKS COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health