Provider Demographics
NPI:1740218940
Name:INDIANA UNIVERSITY HEALTH INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH INC
Other - Org Name:INDIANA UNIVERSITY HEALTH RENAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-962-2380
Mailing Address - Street 1:950 N MERIDIAN ST
Mailing Address - Street 2:ATTEN: JAY COLLINS, GOVERMNET PRGRMS SUITE 800
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1077
Mailing Address - Country:US
Mailing Address - Phone:317-963-1138
Mailing Address - Fax:317-962-4313
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:ROOM 1115
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-944-4283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA UNIVERSITY HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-28
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN153510Medicare Oscar/Certification