| |
5550 S East St Indianapolis IN 46227-1979 | |
(317) 534-4660 | |
(317) 888-8419 |
Full Name | |
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Speciality | Clinic/Center |
Location | 5550 S East St, Indianapolis, Indiana |
Authorized Official Name and Position | Scott Rollett (COO) |
Authorized Official Contact | 3177394895 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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14 Trafalgar Sq Trafalgar IN 46181-9515 Ph: (317) 739-4895 | 5550 S East St Indianapolis IN 46227-1979 Ph: (317) 534-4660 |
NPI Number | 1881061059 |
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Provider Enumeration Date | 08/24/2015 |
Last Update Date | 05/06/2020 |
Medicare PECOS PAC ID | 8426965039 |
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Medicare Enrollment ID | O20150910000116 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881061059 | NPI | - | NPPES |
151957 | Other | IN | MEDICARE FQHC |
200127470F | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Indiana) | Primary |
Moazzam Habib Md Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 9240 N Meridian St, Suite 240, Indianapolis, IN 46260 Phone: 317-571-0030 Fax: 317-571-0031 | |
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