| Indiana Gastroenterology, Inc. | |
|
8902 N Meridian St Ste 225 Indianapolis IN 46260-5382 | |
| (317) 872-1161 | |
| (317) 875-3286 |
| Full Name | Indiana Gastroenterology, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 8902 N Meridian St, Indianapolis, Indiana |
| Authorized Official Name and Position | Paul K Frederick (PRESIDENT) |
| Authorized Official Contact | 3178721161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Gastroenterology, Inc. 8902 N Meridian St Ste 225 Indianapolis IN 46260-5382 Ph: (317) 872-1161 | Indiana Gastroenterology, Inc. 8902 N Meridian St Ste 225 Indianapolis IN 46260-5382 Ph: (317) 872-1161 |
| NPI Number | 1427138817 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 09/26/2012 |
| Medicare PECOS PAC ID | 7012951049 |
|---|---|
| Medicare Enrollment ID | O20050610000540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427138817 | NPI | - | NPPES |
| 100057780A | Medicaid | IN | |
| 50000925A | Other | IN | INDIANA MEDICAL CORPORATION LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 50000925A (Indiana) | Primary |
| Provider Name | William J Fecht |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1184620403 PECOS PAC ID: 2365486396 Enrollment ID: I20050610000555 |
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