Provider Demographics
NPI:1568699122
Name:VERSITI INDIANA, INC.
Entity Type:Organization
Organization Name:VERSITI INDIANA, INC.
Other - Org Name:INDIANA BLOOD CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR - ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-937-6387
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:317-927-1613
Mailing Address - Fax:
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:317-916-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN74465305291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15HL01Medicare Oscar/Certification