Basic Information
| Provider Information | |||||||||
| NPI: | 1659364800 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDIANA HEMOPHILIA & THROMBOSIS CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8326 NAAB RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178710011 | ||||||||
| FaxNumber: | 3178704552 | ||||||||
| Practice Location | |||||||||
| Address1: | 8326 NAAB RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178710000 | ||||||||
| FaxNumber: | 3178710010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOARD | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3178710000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251F00000X | N | Agencies | Home Infusion | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 200184210 | 05 | IN | MEDICAID |