Provider Demographics
NPI:1053058255
Name:INDIANA VASCULAR SURGERY CENTER LLC
Entity Type:Organization
Organization Name:INDIANA VASCULAR SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-644-1404
Mailing Address - Street 1:2140 N CAPITOL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1225
Mailing Address - Country:US
Mailing Address - Phone:317-644-1404
Mailing Address - Fax:
Practice Address - Street 1:2140 N CAPITOL AVE STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1225
Practice Address - Country:US
Practice Address - Phone:317-644-1404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical