| Indiana University Health West Hospital, Inc | |
|
1111 Ronald Reagan Pkwy Building C Avon IN 46123-7085 | |
| (317) 217-3043 | |
| Not Available |
| Full Name | Indiana University Health West Hospital, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1111 Ronald Reagan Pkwy, Avon, Indiana |
| Authorized Official Name and Position | Matthew Bailey (PRESIDENT, CEO) |
| Authorized Official Contact | 3172173043 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana University Health West Hospital, Inc 250 N Shadeland Ave Suite 200 Indianapolis IN 46219-4959 Ph: (317) 962-4836 | Indiana University Health West Hospital, Inc 1111 Ronald Reagan Pkwy Building C Avon IN 46123-7085 Ph: (317) 217-3043 |
| NPI Number | 1801815832 |
|---|---|
| Provider Enumeration Date | 07/19/2006 |
| Last Update Date | 08/03/2012 |
| Medicare PECOS PAC ID | 1456257682 |
|---|---|
| Medicare Enrollment ID | O20120305000472 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801815832 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Siming C Hummer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376591255 PECOS PAC ID: 9537139886 Enrollment ID: I20040726001471 |
| Provider Name | Jessica E Knopp |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023307584 PECOS PAC ID: 3577703685 Enrollment ID: I20140423000705 |
| Provider Name | Trisha Nicole Palencer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972067353 PECOS PAC ID: 4183964679 Enrollment ID: I20190320000662 |
| Provider Name | Ann Shackelford Reeves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487111274 PECOS PAC ID: 1456692250 Enrollment ID: I20190404000257 |
| Provider Name | Elizabeth Mae King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417302845 PECOS PAC ID: 4183952351 Enrollment ID: I20190826003003 |
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