Provider Demographics
NPI:1598776742
Name:INDIANA HEALTH CENTERS, INC.
Entity type:Organization
Organization Name:INDIANA HEALTH CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-576-1335
Mailing Address - Street 1:8003 CASTLEWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1946
Mailing Address - Country:US
Mailing Address - Phone:317-576-1335
Mailing Address - Fax:317-576-1339
Practice Address - Street 1:8003 CASTLEWAY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1946
Practice Address - Country:US
Practice Address - Phone:317-576-1335
Practice Address - Fax:317-576-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN100223780122300000X
IN200443050207Q00000X
IN200527220207R00000X
IN01023827A207V00000X
IN200284500A208000000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1000071250Medicaid
IN151833Medicare ID - Type UnspecifiedJACKSON COUNTY CH CENTER
IN1000071250Medicaid
IN113150Medicare ID - Type UnspecifiedHOSPITAL GROUP NUMBER
IN151815Medicare ID - Type UnspecifiedCASS COUNTY CH CENTER
IN151857Medicare Oscar/Certification