Basic Information
| Provider Information | |||||||||
| NPI: | 1942635214 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | U.S. HEALTHWORKS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5603 W RAYMOND ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462414364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142418266 | ||||||||
| FaxNumber: | 3172474978 | ||||||||
| Practice Location | |||||||||
| Address1: | 5603 W RAYMOND ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462414364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142418266 | ||||||||
| FaxNumber: | 3172474978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2013 | ||||||||
| LastUpdateDate: | 09/05/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KERN | ||||||||
| AuthorizedOfficialFirstName: | BEVERLY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CENTER MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3172418266 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | REGISTERED NURSE | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | 28141357A | IN | Y | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 163W00000X | 01 | IN | REGISTERED NURSE | OTHER |