Provider Demographics
NPI:1235236456
Name:INDIANA MEDICAL SPECIALISTS, INC
Entity Type:Organization
Organization Name:INDIANA MEDICAL SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-514-7217
Mailing Address - Street 1:455 E HOSPITAL LN
Mailing Address - Street 2:P.O. BOX 2240
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4245
Mailing Address - Country:US
Mailing Address - Phone:812-238-1521
Mailing Address - Fax:812-232-0341
Practice Address - Street 1:455 E HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4245
Practice Address - Country:US
Practice Address - Phone:812-238-1521
Practice Address - Fax:812-232-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029981174400000X
IN01049692174400000X
IN01049698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN855920Medicare ID - Type Unspecified
IN150740Medicare PIN