Provider Demographics
NPI:1588607154
Name:SURGERY CENTER OF INDIANAPOLIS LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF INDIANAPOLIS LLC
Other - Org Name:THE SURGERY CENTER OF CARMEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-377-5353
Mailing Address - Street 1:12188 N MERIDIAN ST
Mailing Address - Street 2:150
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4578
Mailing Address - Country:US
Mailing Address - Phone:317-569-8250
Mailing Address - Fax:317-569-8363
Practice Address - Street 1:12188 N MERIDIAN ST
Practice Address - Street 2:150
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4578
Practice Address - Country:US
Practice Address - Phone:317-569-8250
Practice Address - Fax:317-569-8363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INZJ7030Medicare ID - Type Unspecified