Organization
INDIANA HEALTH CENTERS, INC.
Active
Organization
INDIANA HEALTH CENTERS, INC.
Active
Other names
Indiana Health Center @ South Bend
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRACY NAGEL (CHIEF FINANCIAL OFFICER)
(317) 576-1335
Entity
Organization
Contact information
Practice address
1901 W WESTERN AVE, STE B, SOUTH BEND, IN 46619-3521
(574) 234-9033
(574) 847-7200
Mailing address
8003 CASTLEWAY DR, INDIANAPOLIS, IN 46250-1946
(317) 576-1335
(317) 576-1339
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207VX0000X
Obstetrics Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071250 C
—
IN
Enumeration date
09/06/2006
Last updated
03/17/2023
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