Provider Demographics
NPI:1750595765
Name:INDIANA HEALTH CENTERS, INC.
Entity type:Organization
Organization Name:INDIANA HEALTH CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:317-576-1335
Mailing Address - Street 1:INDIANA HEALTH CENTERS, INC.
Mailing Address - Street 2:8003 CASTLEWAY DRIVE
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250
Mailing Address - Country:US
Mailing Address - Phone:317-576-1335
Mailing Address - Fax:317-576-1339
Practice Address - Street 1:TIPTON COUNTY WIC PROGRAM
Practice Address - Street 2:119 WEST WASHINGTON STREET
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072
Practice Address - Country:US
Practice Address - Phone:765-675-8494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare