Provider Demographics
NPI:1316920002
Name:COORDINATED HEALTH LLC
Entity type:Organization
Organization Name:COORDINATED HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE AND CFO/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-522-2349
Mailing Address - Street 1:2145 N. STATE HWY 3
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-7486
Mailing Address - Country:US
Mailing Address - Phone:812-346-6010
Mailing Address - Fax:812-346-6585
Practice Address - Street 1:2145 N. STATE HWY 3
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-7486
Practice Address - Country:US
Practice Address - Phone:812-346-6010
Practice Address - Fax:812-346-6585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COORDINATED HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-28
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200375540Medicaid
IN191350Medicare PIN