Provider Demographics
NPI:1710206990
Name:INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH BALL MEMORIAL PHYSICIANS, INC.
Other - Org Name:IU HEALTH BALL MEMORIAL PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANGETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-751-3311
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:ATTN: CAROL BOYD
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-0413
Mailing Address - Fax:
Practice Address - Street 1:1420 S PILGRIM BLVD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47396-9250
Practice Address - Country:US
Practice Address - Phone:765-759-4068
Practice Address - Fax:765-759-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200986050 CMedicaid
INDQ6230OtherRR MEDICARE
IN200986050 CMedicaid