Provider Demographics
NPI:1922039775
Name:UNIVERSITY TRANSPLANT ASSOCIATES, INC.
Entity Type:Organization
Organization Name:UNIVERSITY TRANSPLANT ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TECTOR
Authorized Official - Suffix:III
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:317-944-4370
Mailing Address - Street 1:550 UNIVERSITY BLVD
Mailing Address - Street 2:UH 4601
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-944-4370
Mailing Address - Fax:317-948-3268
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:UH 4601
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-944-4370
Practice Address - Fax:317-948-3268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037956A204F00000X
IN01036924A204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200023270AMedicaid
IN074690Medicare ID - Type Unspecified