Provider Demographics
NPI:1649695719
Name:COORDINATED CARE CORPORATION
Entity type:Organization
Organization Name:COORDINATED CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP COMPLIANCE & REGULATORY AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:317-684-9478
Mailing Address - Street 1:1099 N MERIDIAN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1075
Mailing Address - Country:US
Mailing Address - Phone:317-684-9478
Mailing Address - Fax:317-684-1785
Practice Address - Street 1:1099 N MERIDIAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1075
Practice Address - Country:US
Practice Address - Phone:317-684-9478
Practice Address - Fax:317-684-1785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTENE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization