Provider Demographics
NPI:1497187991
Name:INDIANA UNIVERSITY HEALTH ADVANCED HEART & LUNG CLINIC
Entity type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH ADVANCED HEART & LUNG CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:UMANA
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:317-962-9700
Mailing Address - Street 1:1801 N. SENATE BLVD.
Mailing Address - Street 2:STE. 2000
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-962-9700
Mailing Address - Fax:317-962-9657
Practice Address - Street 1:1801 N. SENTATE BLVD.
Practice Address - Street 2:STE 2000
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-962-9700
Practice Address - Fax:317-962-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004542B261Q00000X
IN71004542A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center