Provider Demographics
NPI:1326743535
Name:HEALTHTRACKRX INDIANA, INC
Entity type:Organization
Organization Name:HEALTHTRACKRX INDIANA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP RCM ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEILEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-264-1405
Mailing Address - Street 1:1500 INTERSTATE 35 W
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-2402
Mailing Address - Country:US
Mailing Address - Phone:770-759-0289
Mailing Address - Fax:214-975-2276
Practice Address - Street 1:706 E LEWIS AND CLARK PKWY STE 11
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2279
Practice Address - Country:US
Practice Address - Phone:770-759-0289
Practice Address - Fax:214-975-2276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHTRACKRX INDIANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-05
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
15D2267792OtherCLINICAL LABORATORY IMPROVEMENT AMENDMENTS (CLIA)