Provider Demographics
NPI:1912781063
Name:INDIANA CARE NETWORK
Entity type:Organization
Organization Name:INDIANA CARE NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-388-3814
Mailing Address - Street 1:802 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:PA
Mailing Address - Zip Code:15923
Mailing Address - Country:US
Mailing Address - Phone:724-388-3814
Mailing Address - Fax:
Practice Address - Street 1:802 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:PA
Practice Address - Zip Code:15923
Practice Address - Country:US
Practice Address - Phone:724-676-4709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty