| |
2325 E New York St Indianapolis IN 46201-3113 | |
(317) 478-1335 | |
(317) 342-9040 |
Full Name | |
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Speciality | Internal Medicine |
Location | 2325 E New York St, Indianapolis, Indiana |
Authorized Official Name and Position | Bryant Alan King (CEO/OWNERE) |
Authorized Official Contact | 3177579731 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3436 Kenilworth Dr Indianapolis IN 46228-2703 Ph: (317) 757-9731 | 2325 E New York St Indianapolis IN 46201-3113 Ph: (317) 478-1335 |
NPI Number | 1750056586 |
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Provider Enumeration Date | 08/13/2021 |
Last Update Date | 01/23/2025 |
Medicare PECOS PAC ID | 2668879172 |
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Medicare Enrollment ID | O20210927001894 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750056586 | NPI | - | NPPES |
200545640 | Medicaid | IN | |
1720010341 | Other | LA | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
207RN0300X | Internal Medicine - Nephrology | (* (Not Available)) | Secondary |
Provider Name | Bryant A King |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1720010341 PECOS PAC ID: 4688663073 Enrollment ID: I20060109000649 |
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