Provider Demographics
NPI:1669493722
Name:INDIANA NEPHROLOGY AND INTERNAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:INDIANA NEPHROLOGY AND INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHISTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-564-2130
Mailing Address - Street 1:9011 N MERIDIAN ST STE 225
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5365
Mailing Address - Country:US
Mailing Address - Phone:317-574-4747
Mailing Address - Fax:317-574-4737
Practice Address - Street 1:165 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1310
Practice Address - Country:US
Practice Address - Phone:317-773-0363
Practice Address - Fax:317-770-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100226970Medicaid
IN100226970Medicaid
IN796270Medicare PIN