Provider Demographics
NPI:1477659886
Name:SURGICAL ASSOCIATES OF INDIANA, LLC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-682-2038
Mailing Address - Street 1:6350 RUCKER RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4874
Mailing Address - Country:US
Mailing Address - Phone:317-682-2038
Mailing Address - Fax:317-920-7482
Practice Address - Street 1:9660 E 146TH ST STE 100
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3097
Practice Address - Country:US
Practice Address - Phone:317-773-6677
Practice Address - Fax:317-773-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200540630AMedicaid
IN200540630AMedicaid