Provider Demographics
NPI:1386958759
Name:INDIANA HEALTHCARE PHYSICIAN SERVICES INC
Entity type:Organization
Organization Name:INDIANA HEALTHCARE PHYSICIAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEDLEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-357-7334
Mailing Address - Street 1:9 N 7TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1880
Mailing Address - Country:US
Mailing Address - Phone:724-357-7196
Mailing Address - Fax:724-357-7279
Practice Address - Street 1:9 N 7TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1880
Practice Address - Country:US
Practice Address - Phone:724-357-7196
Practice Address - Fax:724-357-7279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017702500010Medicaid
PA0017702500010Medicaid