Provider Demographics
NPI:1609487669
Name:INDIANA NUTRITION GROUP
Entity Type:Organization
Organization Name:INDIANA NUTRITION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YU-HAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-671-5020
Mailing Address - Street 1:450 JACKSON ST UNIT 1335
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6783
Mailing Address - Country:US
Mailing Address - Phone:812-671-5020
Mailing Address - Fax:
Practice Address - Street 1:450 JACKSON ST UNIT 1335
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6783
Practice Address - Country:US
Practice Address - Phone:812-671-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty