Organization
GREATER LAFAYETTE HEALTH SERVICES
Active
Other names
Faith, Hope, and Love Cancer Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRANCE E WILSON (CHIEF EXECUTIVE OFFICER)
(765) 423-6161
Entity
Organization
Contact information
Practice address
1425 UNITY PL, LAFAYETTE, IN 47905-5756
(765) 447-7460
Mailing address
2400 SOUTH ST, LAFAYETTE, IN 47904-3027
Taxonomy
Speciality
Code
Description
License number
State
261QX0203X
Radiation Oncology Clinic/Center
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000311919
ANTHEM
IN
Enumeration date
11/06/2006
Last updated
11/27/2007
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