NPIMap

Organization Active NPI

Indiana Wellness, LLC

  • Specialist
  • Lafayette, IN
National Provider Identifier
1922438522
Registry record updated Nov 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
01060426A Issued in IN
Legal business name
INDIANA WELLNESS, LLC
Practice address
1221 S Creasy LN Ste K3
Lafayette, IN 47905-7430
Phone
(765) 379-1358
Fax
(765) 838-1035
NPI assigned
Nov 18, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Douglas Mennen
Title
Business Manager
Phone
(765) 479-1358

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 01060426A IN Primary

Addresses

Primary practice location

1221 S Creasy LN Ste K3
Lafayette, IN 47905-7430

Mailing address

1221 S Creasy LN Ste K3
Lafayette, IN 47905-7430
Phone (765) 379-1358

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1922438522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 S CREASY LN STE K3",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479057430",
            "telephone_number": "765-379-1358",
            "fax_number": "765-838-1035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 S CREASY LN STE K3",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479057430",
            "telephone_number": "765-379-1358",
            "fax_number": "765-838-1035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-18",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "MENNEN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "765-479-1358"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IN",
            "license": "01060426A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.