| NPI | 1730488818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DALE Chief Finance Officer 317-934-0755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 251S00000X |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2022-01-20 |