Provider Demographics
NPI:1558871681
Name:HIS SOLUTIONS SPECIALTY CARE CORP.
Entity Type:Organization
Organization Name:HIS SOLUTIONS SPECIALTY CARE CORP.
Other - Org Name:HIS SOLUTIONS SPECIALTY CARE, NOT FOR PROFIT C
Other - Org Type:Other Name
Authorized Official - Title/Position:NP / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:765-274-3682
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46015-0188
Mailing Address - Country:US
Mailing Address - Phone:765-610-4609
Mailing Address - Fax:765-610-4609
Practice Address - Street 1:33 W 10TH ST #621
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1493
Practice Address - Country:US
Practice Address - Phone:765-610-4609
Practice Address - Fax:765-610-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty