Provider Demographics
NPI:1699876094
Name:INDIANA UNIVERSITY HEALTH TIPTON HOSPITAL INC
Entity type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH TIPTON HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-675-8501
Mailing Address - Street 1:950 N MERIDIAN ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1077
Mailing Address - Country:US
Mailing Address - Phone:317-963-1138
Mailing Address - Fax:317-962-4313
Practice Address - Street 1:1000 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-9753
Practice Address - Country:US
Practice Address - Phone:765-675-8500
Practice Address - Fax:765-675-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN16-005049-01282NC0060X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270160AMedicaid
IN000000597004OtherANTHEM - FACILITY
IN000000600597OtherANTHEM - LABCORE
IN000000597004OtherANTHEM - FACILITY