Provider Demographics
NPI:1598070740
Name:MD2U INDIANA LLC
Entity Type:Organization
Organization Name:MD2U INDIANA LLC
Other - Org Name:MD2U THE LEADER IN MEDICAL HOUSE CALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-327-9100
Mailing Address - Street 1:PO BOX 7219
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-0219
Mailing Address - Country:US
Mailing Address - Phone:502-327-9100
Mailing Address - Fax:855-632-8329
Practice Address - Street 1:8888 KEYSTONE XING
Practice Address - Street 2:SUITE 1300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4609
Practice Address - Country:US
Practice Address - Phone:502-327-9100
Practice Address - Fax:855-632-8329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MD2U MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-12
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15D2045574OtherCLIA - CERTIFICATE OF WAIVER
IN15D2045574OtherCLIA - CERTIFICATE OF WAIVER