Provider Demographics
NPI:1396175048
Name:INDIANA HEALTH COVERAGE PROGRAM
Entity type:Organization
Organization Name:INDIANA HEALTH COVERAGE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-488-5000
Mailing Address - Street 1:950 N MERIDIAN ST
Mailing Address - Street 2:SUITE 1150
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-4288
Mailing Address - Country:US
Mailing Address - Phone:317-488-5000
Mailing Address - Fax:
Practice Address - Street 1:950 N MERIDIAN ST
Practice Address - Street 2:SUITE 1150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-4288
Practice Address - Country:US
Practice Address - Phone:317-488-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:423-25-6682
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-16
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty