Provider Demographics
NPI:1265413686
Name:NES INDIANA, INC.
Entity type:Organization
Organization Name:NES INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-377-8721
Mailing Address - Street 1:PO BOX 409235
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9235
Mailing Address - Country:US
Mailing Address - Phone:800-377-8721
Mailing Address - Fax:304-523-2241
Practice Address - Street 1:1101 MICHIGAN AVENUE
Practice Address - Street 2:LOGANSPORT MEMORIAL HOSPITAL
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-7013
Practice Address - Country:US
Practice Address - Phone:574-753-7541
Practice Address - Fax:574-753-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000232537OtherBCBS GROUP NUMBER
IN218480Medicare ID - Type UnspecifiedGROUP NUMBER