Provider Demographics
NPI:1194295600
Name:INDY CENTER FOR SLEEP HEALTH LLC
Entity type:Organization
Organization Name:INDY CENTER FOR SLEEP HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICEWANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-999-9977
Mailing Address - Street 1:13578 E 131ST ST STE 101B
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-6400
Mailing Address - Country:US
Mailing Address - Phone:317-999-9977
Mailing Address - Fax:317-219-5580
Practice Address - Street 1:13578 E 131ST ST STE 101B
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6400
Practice Address - Country:US
Practice Address - Phone:317-999-9977
Practice Address - Fax:317-219-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty