Provider Demographics
NPI:1518257765
Name:HILL, JODY
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 S STATE ROAD 1
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:IN
Mailing Address - Zip Code:46742-9498
Mailing Address - Country:US
Mailing Address - Phone:260-316-7669
Mailing Address - Fax:
Practice Address - Street 1:105 S PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1927
Practice Address - Country:US
Practice Address - Phone:260-668-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-012247-1171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20-8500203OtherEIN