Provider Demographics
NPI:1427493527
Name:ST PAUL INTEGRATED HEALTH CENTER LLC
Entity type:Organization
Organization Name:ST PAUL INTEGRATED HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-881-3333
Mailing Address - Street 1:2512 E STOP 11 RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8869
Mailing Address - Country:US
Mailing Address - Phone:317-881-3333
Mailing Address - Fax:317-881-8383
Practice Address - Street 1:2512 E STOP 11 RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8869
Practice Address - Country:US
Practice Address - Phone:317-881-3333
Practice Address - Fax:317-881-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN111N00000X, 207R00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty