Provider Demographics
NPI:1568782373
Name:INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.
Other - Org Name:IU HEALTH BALL MEMORIAL PHYSICIANS PRIMETIME PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANGETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-751-5404
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:ATTN: CAROL BOYD
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-0413
Mailing Address - Fax:
Practice Address - Street 1:205 N TILLOTSON AVE
Practice Address - Street 2:SUITE 201B
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-3996
Practice Address - Country:US
Practice Address - Phone:765-281-4599
Practice Address - Fax:765-751-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200986050 FMedicaid
IN200986050 FMedicaid