Provider Demographics
NPI:1033264288
Name:ASSOCIATES IN FAMILY PRACTICE
Entity Type:Organization
Organization Name:ASSOCIATES IN FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:SIMCOE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-388-1931
Mailing Address - Street 1:5471 GEORGETOWN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5793
Mailing Address - Country:US
Mailing Address - Phone:317-388-1931
Mailing Address - Fax:317-388-1951
Practice Address - Street 1:5471 GEORGETOWN RD
Practice Address - Street 2:SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5793
Practice Address - Country:US
Practice Address - Phone:317-388-1931
Practice Address - Fax:317-388-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000364843OtherANTHEM
INP00322426OtherRR MEDICARE
2708846000OtherPASSPORT ADVANTAGE
INP00322426OtherRR MEDICARE
IN000000364843OtherANTHEM