Provider Demographics
NPI:1235828385
Name:IDEAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:IDEAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUNGO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-730-3956
Mailing Address - Street 1:3881 EAGLE CREEK PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5600
Mailing Address - Country:US
Mailing Address - Phone:317-969-8332
Mailing Address - Fax:317-969-8494
Practice Address - Street 1:3881 EAGLE CREEK PKWY STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5600
Practice Address - Country:US
Practice Address - Phone:317-730-3956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty