Provider Demographics
NPI:1801827696
Name:CARDINAL HEALTH PARTNERS, LLC
Entity Type:Organization
Organization Name:CARDINAL HEALTH PARTNERS, LLC
Other - Org Name:LIBERTY CORNER HEALTH AND DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO PHYSICIAN NETWORK SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANGETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-751-3311
Mailing Address - Street 1:4870 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4432
Mailing Address - Country:US
Mailing Address - Phone:765-284-7277
Mailing Address - Fax:765-284-7472
Practice Address - Street 1:4870 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4432
Practice Address - Country:US
Practice Address - Phone:765-284-7277
Practice Address - Fax:765-284-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100384610FMedicaid
IN100384610FMedicaid