Basic Information
| Provider Information | |||||||||
| NPI: | 1710356563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ESKENAZI HEALTH MEDICAL SUPPLY STORE 38TH STREET | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 ESKENAZI AVE. | ||||||||
| Address2: | FIFTH THIRD BANK FACULTY OFFICE BUILDING/5TH FLOOR | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178803817 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5515 W 38TH ST | ||||||||
| Address2: | ROOM 1512 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462542919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178803838 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2015 | ||||||||
| LastUpdateDate: | 09/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | GUTWEIN | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3172212009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.