Provider Demographics
NPI:1417417718
Name:MDWISE, INC.
Entity Type:Organization
Organization Name:MDWISE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MARKET PERFORMANCE
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:FRICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-822-7320
Mailing Address - Street 1:1200 MADISON AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46225-1616
Mailing Address - Country:US
Mailing Address - Phone:317-822-7306
Mailing Address - Fax:
Practice Address - Street 1:1200 MADISON AVE STE 400
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-1616
Practice Address - Country:US
Practice Address - Phone:317-822-7306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLAREN HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization