Provider Demographics
NPI:1124035027
Name:INDIANA UNIVERSITY HEALTH PAOLI, INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH PAOLI, INC
Other - Org Name:IU HEALTH PAOLI HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-723-7485
Mailing Address - Street 1:642 W HOSPITAL RD
Mailing Address - Street 2:PO BOX 499
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454-9672
Mailing Address - Country:US
Mailing Address - Phone:812-723-7435
Mailing Address - Fax:812-723-7434
Practice Address - Street 1:642 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-9672
Practice Address - Country:US
Practice Address - Phone:812-723-7435
Practice Address - Fax:812-723-7434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005521A3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1535523OtherNCPDP
IN200317930AMedicaid
IN1535523OtherNCPDP