Provider Demographics
NPI:1538296140
Name:VERSITI INDIANA, INC.
Entity Type:Organization
Organization Name:VERSITI INDIANA, INC.
Other - Org Name:CENTRAL INDIANA REGIONAL BLOOD CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER EXEC VP
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-916-5008
Mailing Address - Street 1:3450 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4437
Mailing Address - Country:US
Mailing Address - Phone:317-916-5000
Mailing Address - Fax:317-916-5005
Practice Address - Street 1:3450 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4437
Practice Address - Country:US
Practice Address - Phone:317-916-5000
Practice Address - Fax:317-916-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN070059311331L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes331L00000XSuppliersBlood Bank