Organization
INTEGRATIVE HEALTH SPECIALIST OF INDIANA PC
Active
Organization
INTEGRATIVE HEALTH SPECIALIST OF INDIANA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM GRIDER BUSINESS OFFICE (BUSINESS ADMINISTRATOR)
(317) 781-3604
Entity
Organization
Contact information
Practice address
9333 N MERIDIAN ST, STE 202, INDIANAPOLIS, IN 46260-1872
(317) 580-9333
(317) 818-8933
Mailing address
9333 N MERIDIAN ST, STE 202, INDIANAPOLIS, IN 46260-1872
(317) 580-9333
(317) 818-8933
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000243460
ANTHEM
IN
01
—
1558331652
INDIVIDUAL NPI
IN
01
—
1619947710
INDIVIDUAL NPI
IN
01
—
1629048715
INDIVIDUAL NPI
IN
Enumeration date
05/22/2006
Last updated
06/25/2013
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