Provider Demographics
NPI:1114300340
Name:FRANCISCAN HEALTH LAFAYETTE
Entity type:Organization
Organization Name:FRANCISCAN HEALTH LAFAYETTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
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 1:1701 S CREASY LN
Mailing Address - Street 2:ROOM 1K71
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4972
Mailing Address - Country:US
Mailing Address - Phone:765-428-3550
Mailing Address - Fax:765-428-3551
Practice Address - Street 1:1701 S CREASY LN
Practice Address - Street 2:ROOM 1K71
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-428-3550
Practice Address - Fax:765-428-3551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN HEALTH LAFAYETTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-07
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201341420Medicaid