Provider Demographics
NPI:1730488818
Name:JANE PAULEY COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:JANE PAULEY COMMUNITY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-934-0755
Mailing Address - Street 1:1503 N MITTHOEFFER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2425
Mailing Address - Country:US
Mailing Address - Phone:317-355-9320
Mailing Address - Fax:317-355-9319
Practice Address - Street 1:1503 N MITTHOEFFER RD STE 150
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2425
Practice Address - Country:US
Practice Address - Phone:317-934-0755
Practice Address - Fax:317-469-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201026910Medicaid
IN201026910Medicaid
IN151907Medicare PIN
IN151909Medicare PIN
IN15-1870Medicare PIN
IN151906Medicare PIN
IN151915Medicare PIN
IN151910Medicare PIN
IN151922Medicare PIN