Provider Demographics
NPI:1285651976
Name:INDIGO HEALTH CLINIC, PC
Entity Type:Organization
Organization Name:INDIGO HEALTH CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GOVINDA
Authorized Official - Middle Name:CHANDRA
Authorized Official - Last Name:SATAPATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-849-1988
Mailing Address - Street 1:8753 W IRMA LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-6440
Mailing Address - Country:US
Mailing Address - Phone:623-849-1988
Mailing Address - Fax:623-849-1981
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:#285
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-849-1988
Practice Address - Fax:623-849-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ371203Medicaid
AZZ69049Medicare PIN