Basic Information
Provider Information
NPI: 1588007983
EntityType: 2
ReplacementNPI:  
OrganizationName: FRANCISCAN PHYSICIAN NETWORK
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1040 SIERRA DRIVE
Address2: SUITE 400
City: GREENWOOD
State: IN
PostalCode: 461437241
CountryCode: US
TelephoneNumber: 3175284291
FaxNumber: 3178651479
Practice Location
Address1: 1702 LAFAYETTE RD
Address2:  
City: CRAWFORDSVILLE
State: IN
PostalCode: 479331033
CountryCode: US
TelephoneNumber: 7653624400
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/16/2013
LastUpdateDate: 09/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PHALEN
AuthorizedOfficialFirstName: DONNA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: ABO DIRECTOR
AuthorizedOfficialTelephone: 2195544548
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332B00000X  Y SuppliersDurable Medical Equipment & Medical Supplies 

No ID Information.


Home