Provider Demographics
NPI:1134300205
Name:HEALTH 1ST OF INDY SW
Entity Type:Organization
Organization Name:HEALTH 1ST OF INDY SW
Other - Org Name:HEALTH 1ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:TOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-856-4800
Mailing Address - Street 1:7015 S KENTUCKY AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-9304
Mailing Address - Country:US
Mailing Address - Phone:317-856-4800
Mailing Address - Fax:
Practice Address - Street 1:7015 S KENTUCKY AVE STE 109
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-9304
Practice Address - Country:US
Practice Address - Phone:317-856-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty