Provider Demographics
NPI:1285669408
Name:CARDINAL HEALTH PARTNERS, LLC
Entity Type:Organization
Organization Name:CARDINAL HEALTH PARTNERS, LLC
Other - Org Name:PRIMETIME PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO PHYSICIAN NETWORK SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANGETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-730-5109
Mailing Address - Street 1:205 N TILLOTSON AVE
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3900
Mailing Address - Country:US
Mailing Address - Phone:765-281-4599
Mailing Address - Fax:765-751-2335
Practice Address - Street 1:205 N TILLOTSON AVE
Practice Address - Street 2:SUITE 201B
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-3900
Practice Address - Country:US
Practice Address - Phone:765-281-4599
Practice Address - Fax:765-751-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200227660AMedicaid
IN226200Medicare ID - Type Unspecified