Provider Demographics
NPI:1003897448
Name:NORTHWEST SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NORTHWEST SURGERY CENTER LLC
Other - Org Name:FOOT & ANKLE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-621-7509
Mailing Address - Street 1:8651 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1578
Mailing Address - Country:US
Mailing Address - Phone:317-621-3010
Mailing Address - Fax:317-621-3011
Practice Address - Street 1:8651 TOWNSHIP LINE ROAD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1578
Practice Address - Country:US
Practice Address - Phone:317-621-3010
Practice Address - Fax:317-621-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN61100198B261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000098120OtherANTHEM PIN NUMBER
IN200066340AMedicaid
IN200066340Medicaid
IN200066340AMedicaid