Provider Demographics
NPI:1982631990
Name:INDIANA UNIVERSITY HEALTH INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH INC
Other - Org Name:INDIANA UNIVERSITY HEALTH ADULT DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-962-2380
Mailing Address - Street 1:950 N MERIDIAN ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1077
Mailing Address - Country:US
Mailing Address - Phone:317-963-1138
Mailing Address - Fax:317-962-4313
Practice Address - Street 1:2140 N CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1225
Practice Address - Country:US
Practice Address - Phone:317-920-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA UNIVERSITY HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-26
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN153515Medicare Oscar/Certification