Provider Demographics
NPI:1235250788
Name:STATE OF INDIANA AUDITOR OF STATE
Entity Type:Organization
Organization Name:STATE OF INDIANA AUDITOR OF STATE
Other - Org Name:EVANSVILLE STATE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-469-6800
Mailing Address - Street 1:3400 LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:812-469-6800
Mailing Address - Fax:812-468-6847
Practice Address - Street 1:3400 LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714
Practice Address - Country:US
Practice Address - Phone:812-469-6800
Practice Address - Fax:812-469-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200394490Medicaid
IN200394490Medicaid