Provider Demographics
NPI:1568864387
Name:MILLS, JOSHUA A (PA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:MILLS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E COUNTY LINE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-0990
Mailing Address - Country:US
Mailing Address - Phone:317-497-6497
Mailing Address - Fax:317-497-6400
Practice Address - Street 1:1550 E COUNTY LINE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0990
Practice Address - Country:US
Practice Address - Phone:317-497-6497
Practice Address - Fax:317-497-6400
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001681A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000898138OtherANTHEM
IN201260440Medicaid
IN4966231OtherAETNA
IN215670003Medicare PIN