Basic Information
| Provider Information | |||||||||
| NPI: | 1306947189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HENDRICKS COUNTY HOSPITAL | ||||||||
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| OtherOrganizationName: | AVON INTERNAL 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: | 8244 E US HIGHWAY 36 | ||||||||
| Address2: | SUITE 1320 | ||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461239575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172727519 | ||||||||
| FaxNumber: | 3172723661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 06/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | KLAYER | ||||||||
| AuthorizedOfficialFirstName: | GENI | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN NETWORK DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3178375571 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN,BSN,MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.