Provider Demographics
NPI:1093021875
Name:IOH SOUTH SURGERY CENTER
Entity Type:Organization
Organization Name:IOH SOUTH SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-802-2000
Mailing Address - Street 1:1260 INNOVATION PARKWAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-5255
Mailing Address - Country:US
Mailing Address - Phone:317-884-5255
Mailing Address - Fax:317-884-5361
Practice Address - Street 1:1260 INNOVATION PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:317-884-5255
Practice Address - Fax:317-884-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical