Provider Demographics
NPI:1609198266
Name:ADVANCED PRIMARY CARE ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-577-6056
Mailing Address - Street 1:9840 WESTPOINT DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3360
Mailing Address - Country:US
Mailing Address - Phone:317-577-6056
Mailing Address - Fax:317-577-6059
Practice Address - Street 1:9840 WESTPOINT DR
Practice Address - Street 2:SUITE 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3360
Practice Address - Country:US
Practice Address - Phone:317-577-6056
Practice Address - Fax:317-577-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047166A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200213060Medicaid
139880Medicare PIN
G99282Medicare UPIN