Provider Demographics
NPI:1851774095
Name:FRANCISCAN ALLIANCE, INC
Entity Type:Organization
Organization Name:FRANCISCAN ALLIANCE, INC
Other - Org Name:FRANCISCAN OUTPATIENT PHARMACY - MICHIGAN CITY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR-AMBULATORY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BITNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:317-528-6047
Mailing Address - Street 1:3500 FRANCISCAN WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-0021
Mailing Address - Country:US
Mailing Address - Phone:219-878-8300
Mailing Address - Fax:219-878-8301
Practice Address - Street 1:3500 FRANCISCAN WAY FL 1
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-0021
Practice Address - Country:US
Practice Address - Phone:219-878-8300
Practice Address - Fax:219-878-8301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN ALLIANCE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-07
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201334460Medicaid