Provider Demographics
NPI:1992986665
Name:HEALTH 1ST OF INDY NW
Entity type:Organization
Organization Name:HEALTH 1ST OF INDY NW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:TOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-496-2530
Mailing Address - Street 1:5035 W 71ST ST STE E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-5114
Mailing Address - Country:US
Mailing Address - Phone:317-496-2530
Mailing Address - Fax:
Practice Address - Street 1:5035 W 71ST ST STE E
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-5114
Practice Address - Country:US
Practice Address - Phone:317-496-2530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies