Provider Demographics
NPI:1457519324
Name:INDIANA UNIVERSITY HEALTH PAOLI INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH PAOLI INC
Other - Org Name:IU HEALTH PAOLI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-723-7430
Mailing Address - Street 1:642 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454-9672
Mailing Address - Country:US
Mailing Address - Phone:812-723-2811
Mailing Address - Fax:812-723-7506
Practice Address - Street 1:642 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-9672
Practice Address - Country:US
Practice Address - Phone:812-723-2811
Practice Address - Fax:812-723-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN163460Medicaid