Provider Demographics
NPI:1962772905
Name:INDIANA UNIVERSITY HEALTH, INC
Entity type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:317-374-8331
Mailing Address - Street 1:705 RILEY HOSPITAL DR
Mailing Address - Street 2:SUITE 1960
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5109
Mailing Address - Country:US
Mailing Address - Phone:317-374-8331
Mailing Address - Fax:317-944-3939
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:SUITE 1960
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-374-8331
Practice Address - Fax:317-944-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003801A281PC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281PC2000XHospitalsChronic Disease HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100335320Medicaid
IN100335390Medicaid
IN200340080Medicaid