Basic Information
| Provider Information | |||||||||
| NPI: | 1700130903 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VERVE HEALTH LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VERVE HEALTH AT KOKOMO | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 HAVERSTICK RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462404308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175737600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 620 N BELL ST | ||||||||
| Address2: | |||||||||
| City: | KOKOMO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469013072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654567330 | ||||||||
| FaxNumber: | 7654562018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2012 | ||||||||
| LastUpdateDate: | 05/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | ERB | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3175737600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 02002977A | IN | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 332900000X | 02002977A | IN | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.