Provider Demographics
NPI:1285983080
Name:PLANNED PARENTHOOD OF INDIANA BLOOMINGTON
Entity type:Organization
Organization Name:PLANNED PARENTHOOD OF INDIANA BLOOMINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE & ADMINISTR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNAH
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:OVERHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:317-637-4166
Mailing Address - Street 1:200 S. MERIDIAN ST.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46225
Mailing Address - Country:US
Mailing Address - Phone:317-637-4343
Mailing Address - Fax:317-637-4344
Practice Address - Street 1:421 S. COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-1514
Practice Address - Country:US
Practice Address - Phone:812-336-0219
Practice Address - Fax:812-330-7352
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLANNED PARENTHOOD OF INDIANA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041899A261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2002955610Medicaid
IN100326600Medicaid
IN266310Medicare PIN
IN100326600Medicaid