Provider Demographics
NPI:1609323708
Name:CARRIE B. BOYD HEALTHCARE CENTER
Entity Type:Organization
Organization Name:CARRIE B. BOYD HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:V
Authorized Official - Last Name:CORK
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MAT
Authorized Official - Phone:317-501-0210
Mailing Address - Street 1:PO BOX 7140
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-7140
Mailing Address - Country:US
Mailing Address - Phone:317-501-0210
Mailing Address - Fax:
Practice Address - Street 1:5555 N TACOMA AVE
Practice Address - Street 2:12
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3512
Practice Address - Country:US
Practice Address - Phone:317-501-0210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003708A261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service