| NPI | 1659814044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY WESTFALL Fa Aco Regional VP 317-782-6671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IN 31316) |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2016-12-02 |