Provider Demographics
NPI:1043213648
Name:NEUROSURGICAL ASSOCIATES OF INDIANA, PC
Entity Type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES OF INDIANA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-577-3900
Mailing Address - Street 1:7369 SHADELAND STATION WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3958
Mailing Address - Country:US
Mailing Address - Phone:317-577-3900
Mailing Address - Fax:317-579-7459
Practice Address - Street 1:7369 SHADELAND STATION WAY
Practice Address - Street 2:STE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3958
Practice Address - Country:US
Practice Address - Phone:317-577-3900
Practice Address - Fax:317-579-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032585207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D94388Medicare UPIN
IN0374700Medicare ID - Type Unspecified