Provider Demographics
NPI:1598814733
Name:ADKINS MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:ADKINS MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-300-0370
Mailing Address - Street 1:5162 E STOP 11 RD STE 6
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8618
Mailing Address - Country:US
Mailing Address - Phone:317-300-0370
Mailing Address - Fax:317-300-0422
Practice Address - Street 1:5162 E STOP 11 RD STE 6
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8618
Practice Address - Country:US
Practice Address - Phone:317-300-0370
Practice Address - Fax:317-300-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
29580Medicare PIN
INE03607Medicare UPIN