Provider Demographics
NPI:1396765731
Name:INDIANA UNIVERSITY HEALTH NORTH HOSPITAL, INC
Entity type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH NORTH HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-962-4836
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-4836
Mailing Address - Fax:317-962-4392
Practice Address - Street 1:11725 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3008
Practice Address - Country:US
Practice Address - Phone:317-962-4836
Practice Address - Fax:317-962-4391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA UNIVERSITY HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200815390AMedicaid
INM100072757Medicare PIN