Provider Demographics
NPI:1316764012
Name:CAREATC - INDIANA PACKERS HEALTH CENTER
Entity type:Organization
Organization Name:CAREATC - INDIANA PACKERS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR, DATA & ANALYTICS
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7475
Mailing Address - Street 1:4500 S 129TH EAST AVE STE 191
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5891
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1165 N US HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-8722
Practice Address - Country:US
Practice Address - Phone:765-564-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAREATC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty