Basic Information
Provider Information
NPI: 1427350826
EntityType: 2
ReplacementNPI:  
OrganizationName: FRANCISCAN ST. FRANCIS HEALTH
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: IMMEDIATE CARE CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8111 S EMERSON AVE
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462378601
CountryCode: US
TelephoneNumber: 3177826621
FaxNumber:  
Practice Location
Address1: 1001 N MADISON AVE
Address2:  
City: GREENWOOD
State: IN
PostalCode: 461424135
CountryCode: US
TelephoneNumber: 3178883508
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/17/2010
LastUpdateDate: 08/14/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BRODY
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT AND CEO
AuthorizedOfficialTelephone: 3177826621
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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