Provider Demographics
NPI:1174855696
Name:INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.
Other - Org Name:IU HEALTH BALL MEMORIAL PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-747-3251
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:ATTN: CAROL BOYD
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-0413
Mailing Address - Fax:
Practice Address - Street 1:2901 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4307
Practice Address - Country:US
Practice Address - Phone:765-751-2765
Practice Address - Fax:765-751-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
INRR CA1092OtherRR MEDICARE
IN200452010AMedicaid
INRR CA1092OtherRR MEDICARE