Provider Demographics
NPI:1568525707
Name:INDIANA ORTHOPAEDIC CENTER
Entity Type:Organization
Organization Name:INDIANA ORTHOPAEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-863-2180
Mailing Address - Street 1:7930 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250
Mailing Address - Country:US
Mailing Address - Phone:317-588-2663
Mailing Address - Fax:317-588-2727
Practice Address - Street 1:1 MEMORIAL SQUARE
Practice Address - Street 2:SUITE 115
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140
Practice Address - Country:US
Practice Address - Phone:317-588-2663
Practice Address - Fax:317-462-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN897960Medicare ID - Type Unspecified