Provider Demographics
NPI:1912984451
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:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-353-9171
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:2005-12-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200317930Medicaid
IN000000076086OtherBLUE CROSS
IN200352690Medicaid
IN200318330Medicaid
IN200368930Medicaid
IN000000107664OtherBLUE SHIELD
IN200318450Medicaid
IN200317930Medicaid
INCC9320Medicare ID - Type UnspecifiedMEDICARE ANESTHESIA
IN000000076086OtherBLUE CROSS
INCH0317Medicare ID - Type UnspecifiedMEDICARE RAILROAD
IN163460Medicare ID - Type UnspecifiedMEDICARE PART B PHYSICIAN
IN15Z306Medicare Oscar/Certification