Provider Demographics
NPI:1508260712
Name:INDIANA UNIVERSITY HEALTH NORTH HOSPITAL, INC.
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH NORTH HOSPITAL, INC.
Other - Org Name:INDIANA UNIVERSITY HEALTH NORTH HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-688-2072
Mailing Address - Street 1:11700 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11700 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4656
Practice Address - Country:US
Practice Address - Phone:317-688-2072
Practice Address - Fax:317-688-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201269880AMedicaid