Provider Demographics
NPI:1689980765
Name:INDIANA OB/GYN P.C.
Entity Type:Organization
Organization Name:INDIANA OB/GYN P.C.
Other - Org Name:INDIANA OBSTETRICS & GYNECOLOGY P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-341-3116
Mailing Address - Street 1:7830 MADISON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5607
Mailing Address - Country:US
Mailing Address - Phone:317-887-4400
Mailing Address - Fax:317-887-4401
Practice Address - Street 1:7830 MADISON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5607
Practice Address - Country:US
Practice Address - Phone:317-887-4400
Practice Address - Fax:317-887-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062931A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200853410Medicaid
IN200853410Medicaid