Organization
THE PROVIDER NETWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEWART CLARK (PRESIDENT)
(317) 507-4280
Entity
Organization
Contact information
Practice address
11688 LAKE FOREST PKWY, CARMEL, IN 46033-7208
(317) 507-4280
Mailing address
11688 LAKE FOREST PKWY, CARMEL, IN 46033-7208
(317) 507-4280
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008876230A
IHCP FIRST STEPS
IN
Enumeration date
02/14/2008
Last updated
02/14/2008
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