Provider Demographics
NPI:1417141144
Name:UNITY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:UNITY HEALTHCARE, LLC
Other - Org Name:UNITY IMMEDIATE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-446-5417
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-446-5317
Practice Address - Street 1:1321 UNITY PL
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5793
Practice Address - Country:US
Practice Address - Phone:765-446-1362
Practice Address - Fax:765-446-1007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITY HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-06
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038745A261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000547591OtherANTHEM
IN815150Medicare PIN
INCD6272Medicare PIN
IN1272900011Medicare NSC