Provider Demographics
NPI:1134292832
Name:INDIANA URGENT CARE CENTERS, LLC
Entity Type:Organization
Organization Name:INDIANA URGENT CARE CENTERS, LLC
Other - Org Name:INDY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:E. STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARDATZKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-471-0001
Mailing Address - Street 1:3479 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1948
Mailing Address - Country:US
Mailing Address - Phone:317-471-0001
Mailing Address - Fax:317-471-0002
Practice Address - Street 1:3479 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1948
Practice Address - Country:US
Practice Address - Phone:317-471-0001
Practice Address - Fax:317-471-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053617A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN940470EEMedicare ID - Type Unspecified
IN53598Medicare UPIN