Provider Demographics
NPI:1417553157
Name:SPENCER WELLNESS CENTRE LLC
Entity Type:Organization
Organization Name:SPENCER WELLNESS CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-588-1000
Mailing Address - Street 1:7202 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1938
Mailing Address - Country:US
Mailing Address - Phone:317-588-1000
Mailing Address - Fax:317-588-3003
Practice Address - Street 1:7202 E 71ST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1938
Practice Address - Country:US
Practice Address - Phone:317-588-1000
Practice Address - Fax:317-588-3003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPENCER WELLNESS CENTRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-08
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty