Basic Information
| Provider Information | |||||||||
| NPI: | 1568407310 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ESKENAZI HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 720 ESKENAZI AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178804055 | ||||||||
| FaxNumber: | 3178800406 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 ESKENAZI AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178804055 | ||||||||
| FaxNumber: | 3178800406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3178804873 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 100268860A | IN | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 332B00000X | 100050231 | IN | N | Suppliers | Durable Medical Equipment & Medical Supplies | 3416L0300X | 100268700A | IN | N | Transportation Services | Ambulance | Land Transport | 282N00000X | 06-005023-1 | IN | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100268850A | 05 | IN | MEDICAID | 100286700A | 05 | IN | MEDICAID | FM-200152510A | 05 | IN | MEDICAID | 100268860A | 05 | IN | MEDICAID | R-100291690A | 05 | IN | MEDICAID | W-200152610A | 05 | IN | MEDICAID | GC-200152590A | 05 | IN | MEDICAID | NA-200152640A | 05 | IN | MEDICAID | CC-200152530A | 05 | IN | MEDICAID | 000000098273 | 01 | IN | ANTHEM/WELLPOINT | OTHER | 100268870A | 05 | IN | MEDICAID | B-200152540A | 05 | IN | MEDICAID | M-200152600A | 05 | IN | MEDICAID | MY-100291690B | 05 | IN | MEDICAID | 100268860B | 05 | IN | MEDICAID | PC-200152630A | 05 | IN | MEDICAID |