Provider Demographics
NPI:1689978710
Name:HEALTH1ST OF INDY NW
Entity Type:Organization
Organization Name:HEALTH1ST OF INDY NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-683-1970
Mailing Address - Street 1:1420 SADLIER CIRCLE E DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-0000
Mailing Address - Country:US
Mailing Address - Phone:317-683-1970
Mailing Address - Fax:317-683-1989
Practice Address - Street 1:8258 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-0000
Practice Address - Country:US
Practice Address - Phone:317-429-5400
Practice Address - Fax:317-429-5401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH1ST OF GREENFIELD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty