Provider Demographics
NPI:1679687503
Name:RICHARD L. ROUDEBUSH VA MEDICAL CENTER
Entity Type:Organization
Organization Name:RICHARD L. ROUDEBUSH VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADOU
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:317-988-2623
Mailing Address - Street 1:12306 BLUE SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4053
Mailing Address - Country:US
Mailing Address - Phone:317-576-9867
Mailing Address - Fax:
Practice Address - Street 1:3602 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-3466
Practice Address - Country:US
Practice Address - Phone:317-988-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital