| |
501 N East St Indianapolis IN 46204-1632 | |
(317) 880-5175 | |
(317) 822-5501 |
Full Name | |
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Speciality | Clinic/Center |
Location | 501 N East St, Indianapolis, Indiana |
Authorized Official Name and Position | Christopher M Scott (CHIEF CLINICAL AND REVENUE OFFICER) |
Authorized Official Contact | 3178804440 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 637764 Cincinnati OH 45263-7764 Ph: (317) 880-4055 | 501 N East St Indianapolis IN 46204-1632 Ph: (317) 880-5175 |
NPI Number | 1336480631 |
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Provider Enumeration Date | 03/12/2013 |
Last Update Date | 09/05/2023 |
Medicare PECOS PAC ID | 6709795974 |
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Medicare Enrollment ID | O20150902002360 |
Identifier | Type | State | Issuer |
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1336480631 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Indiana) | Primary |
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