Provider Demographics
NPI:1972915817
Name:INDIANA UNIVERSITY
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCY COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-274-4966
Mailing Address - Street 1:19100 CREST AVE
Mailing Address - Street 2:APT 88
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-8661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19100 CREST AVE
Practice Address - Street 2:APT 88
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-8661
Practice Address - Country:US
Practice Address - Phone:818-464-8207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital