Provider Demographics
NPI:1093905325
Name:INDIANAPOLIS NEUROSURGICAL GROUP
Entity Type:Organization
Organization Name:INDIANAPOLIS NEUROSURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEFTHERI
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:317-396-1386
Mailing Address - Street 1:8333 NAAB RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5924
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-396-1346
Practice Address - Street 1:1801 N SENATE AVE
Practice Address - Street 2:SUITE 535
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-396-1300
Practice Address - Fax:137-396-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000658A282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital