Basic Information
| Provider Information | |||||||||
| NPI: | 1063640258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HENDRICKS COUNTY HOSPITAL | ||||||||
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| OtherOrganizationName: | HENDRICKS ORTHOPEDICS AND SPORTS MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 SOUTHFIELD DR | ||||||||
| Address2: | SUITE 1370 | ||||||||
| City: | PLAINFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461684498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178375571 | ||||||||
| FaxNumber: | 3178375580 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HOSPITAL LN | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DANVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461222000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177184676 | ||||||||
| FaxNumber: | 3177182476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | HETTWER | ||||||||
| AuthorizedOfficialFirstName: | APRIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3178375566 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207XX0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.