Provider Demographics
NPI:1174824908
Name:HIS SOLUTIONS HEALTH CARE LLC
Entity Type:Organization
Organization Name:HIS SOLUTIONS HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:765-393-3457
Mailing Address - Street 1:720 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-1206
Mailing Address - Country:US
Mailing Address - Phone:765-393-3457
Mailing Address - Fax:765-393-3458
Practice Address - Street 1:720 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1206
Practice Address - Country:US
Practice Address - Phone:765-393-3457
Practice Address - Fax:765-393-3458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207Q00000X, 207Q00000X
163WA0400X, 163WC1500X, 164W00000X, 363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201323020AMedicaid
IN201323020AMedicaid