Provider Demographics
NPI:1962433763
Name:CARDINAL HEALTH PARTNERS, LLC
Entity type:Organization
Organization Name:CARDINAL HEALTH PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO PHYSICIAN NETWORK SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANGETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-751-3311
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46989-0690
Mailing Address - Country:US
Mailing Address - Phone:765-998-6200
Mailing Address - Fax:765-998-6204
Practice Address - Street 1:1809 S MAIN ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:IN
Practice Address - Zip Code:46989
Practice Address - Country:US
Practice Address - Phone:765-998-6200
Practice Address - Fax:765-998-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200132640AMedicaid
IN200132640AMedicaid