Provider Demographics
NPI:1285837773
Name:BEECH GROVE FOOT CARE INC
Entity Type:Organization
Organization Name:BEECH GROVE FOOT CARE INC
Other - Org Name:INDY SOUTH FOOT ANDANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-300-0106
Mailing Address - Street 1:7855 S EMERSON AVE
Mailing Address - Street 2:SUITE T
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8668
Mailing Address - Country:US
Mailing Address - Phone:317-300-0106
Mailing Address - Fax:317-497-8383
Practice Address - Street 1:7855 S. EMERSON AVE
Practice Address - Street 2:SUITE T
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237
Practice Address - Country:US
Practice Address - Phone:317-300-0106
Practice Address - Fax:317-497-8383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDY SOUTH FOOT & ANKLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-11
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000694A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN87821OtherBCBS/ANTHEM PROV #
INCB3164OtherMEDICARE RAILROAD
IN87821OtherBCBS/ANTHEM PROV #
INT86380Medicare UPIN
IN0359000001Medicare NSC