| NPI | 1740410281 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLENE BURTRUM Chief Executive Officer 317-396-0280 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2009-07-20 |