Provider Demographics
NPI:1578017182
Name:MEDICAL SPECIALTY LLC
Entity Type:Organization
Organization Name:MEDICAL SPECIALTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBASPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-842-5771
Mailing Address - Street 1:7320 E 82ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1458
Mailing Address - Country:US
Mailing Address - Phone:317-842-5771
Mailing Address - Fax:317-576-1394
Practice Address - Street 1:2301 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5729
Practice Address - Country:US
Practice Address - Phone:317-602-5610
Practice Address - Fax:317-602-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
IN01034573A207QA0401X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty