Provider Demographics
NPI:1346210259
Name:SURGICARE LLC
Entity Type:Organization
Organization Name:SURGICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-339-8000
Mailing Address - Street 1:2907 MCINTYRE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4209
Mailing Address - Country:US
Mailing Address - Phone:812-339-8000
Mailing Address - Fax:812-339-2524
Practice Address - Street 1:2907 MCINTYRE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4209
Practice Address - Country:US
Practice Address - Phone:812-339-8000
Practice Address - Fax:812-339-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000098138OtherANTHEM BLUE SHIELD
INZB0750OtherTRAVELERS MEDICARE
INZB0750OtherTRAVELERS MEDICARE
INZB0750Medicare ID - Type Unspecified