Provider Demographics
NPI:1881646263
Name:UNITY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:UNITY HEALTHCARE, LLC
Other - Org Name:LAFAYETTE SURGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-446-5286
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-446-5417
Mailing Address - Fax:765-446-5317
Practice Address - Street 1:1345 UNITY PL
Practice Address - Street 2:SUITE 235
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5761
Practice Address - Country:US
Practice Address - Phone:765-446-5065
Practice Address - Fax:765-446-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN208600000X208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200107480FMedicaid
INCC9831Medicare PIN
IN200107480FMedicaid