Provider Demographics
NPI:1417042003
Name:THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
Entity Type:Organization
Organization Name:THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
Other - Org Name:GRASSY CREEK COMMUNITY HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OUTPATIENT PHCY
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:317-880-4340
Mailing Address - Street 1:720 ESKENAZI AVENUE
Mailing Address - Street 2:FIFTH THIRD BANK BUILDING, 5TH FLOOR
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-3999
Mailing Address - Fax:317-880-0343
Practice Address - Street 1:9443 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235
Practice Address - Country:US
Practice Address - Phone:317-890-2123
Practice Address - Fax:317-890-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60004994B3336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200152590AMedicaid
2023331OtherPK