Provider Demographics
NPI:1346324969
Name:INDIANA WOMENS ONCOLOGY PC
Entity Type:Organization
Organization Name:INDIANA WOMENS ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-415-6700
Mailing Address - Street 1:PO BOX 78226
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-0226
Mailing Address - Country:US
Mailing Address - Phone:317-415-6700
Mailing Address - Fax:317-415-6707
Practice Address - Street 1:8301 HARCOURT RD
Practice Address - Street 2:STE 201
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-415-6700
Practice Address - Fax:317-415-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000345948OtherANTHEM
220320Medicare ID - Type Unspecified