Provider Demographics
NPI:1467424689
Name:MAX HEALTH CLINIC INC.
Entity Type:Organization
Organization Name:MAX HEALTH CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARADHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:219-805-6923
Mailing Address - Street 1:1000, EAGLE RIDGE DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375
Mailing Address - Country:US
Mailing Address - Phone:219-805-6923
Mailing Address - Fax:219-865-9020
Practice Address - Street 1:1000 EAGLE RIDGE DR
Practice Address - Street 2:SUITE B
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-4207
Practice Address - Country:US
Practice Address - Phone:219-805-6923
Practice Address - Fax:219-865-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004937A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232660Medicare ID - Type Unspecified