Provider Demographics
NPI:1568812949
Name:INDIANA UNIVERSITY-METHODIST HOSPITAL
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY-METHODIST HOSPITAL
Other - Org Name:CLARIAN HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VASCULAR INTERVENTIONAL TECH
Authorized Official - Prefix:DR
Authorized Official - First Name:STYESTOVIA
Authorized Official - Middle Name:YESTEE
Authorized Official - Last Name:STLAUDEREAS
Authorized Official - Suffix:
Authorized Official - Credentials:JD:/MD;DDO:FACES:PHA
Authorized Official - Phone:317-962-2000
Mailing Address - Street 1:8035 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-6401
Mailing Address - Country:US
Mailing Address - Phone:317-962-2000
Mailing Address - Fax:317-962-2003
Practice Address - Street 1:1802 N SENATE AVE
Practice Address - Street 2:WEST SUITE 402
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-962-2000
Practice Address - Fax:317-962-2003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA -PURDUE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN881093302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization