Provider Demographics
NPI:1194756304
Name:CARDINAL HEALTH PARTNERS, LLC
Entity type:Organization
Organization Name:CARDINAL HEALTH PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO PHYSICIAN NETWORK SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANGETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-751-3311
Mailing Address - Street 1:349 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47320-1705
Mailing Address - Country:US
Mailing Address - Phone:765-789-4545
Mailing Address - Fax:765-789-4131
Practice Address - Street 1:349 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47320-1705
Practice Address - Country:US
Practice Address - Phone:765-789-4545
Practice Address - Fax:765-789-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200132620AMedicaid
IN200132620AMedicaid