Provider Demographics
NPI:1497792360
Name:WOMEN'S PHYSICIAN SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:WOMEN'S PHYSICIAN SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-228-1100
Mailing Address - Street 1:PO BOX 2303
Mailing Address - Street 2:DEPT. #175
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2303
Mailing Address - Country:US
Mailing Address - Phone:317-802-3127
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:8081 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2087
Practice Address - Country:US
Practice Address - Phone:317-228-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INNEVER ISSUEDMedicaid
INNEVER ISSUEDMedicaid