Provider Demographics
NPI:1174654305
Name:STATE OF INDIANA, AUDITOR OF STATE
Entity Type:Organization
Organization Name:STATE OF INDIANA, AUDITOR OF STATE
Other - Org Name:NEURODIAGNOSTIC INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER, INDIANA FAMILY & SOCIAL
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-232-7862
Mailing Address - Street 1:5435 EAST 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-5101
Mailing Address - Country:US
Mailing Address - Phone:317-941-4000
Mailing Address - Fax:317-941-4378
Practice Address - Street 1:5435 EAST 16TH STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-5101
Practice Address - Country:US
Practice Address - Phone:317-941-4000
Practice Address - Fax:317-941-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN154008Medicare ID - Type Unspecified