Provider Demographics
NPI:1740527373
Name:FRANCISCAN HEALTH LAFAYETTE
Entity type:Organization
Organization Name:FRANCISCAN HEALTH LAFAYETTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-502-4000
Mailing Address - Street 1:PO BOX 781019
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1019
Mailing Address - Country:US
Mailing Address - Phone:765-502-4000
Mailing Address - Fax:
Practice Address - Street 1:1425 UNITY PL
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5756
Practice Address - Country:US
Practice Address - Phone:765-447-7460
Practice Address - Fax:765-447-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2085R0001X, 261QX0203X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, RadiationGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN258760Medicare PIN