Provider Demographics
NPI:1609889526
Name:INDIANA GENERAL SURGERY, P.C.
Entity Type:Organization
Organization Name:INDIANA GENERAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:317-924-4009
Mailing Address - Street 1:3520 GUION RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1692
Mailing Address - Country:US
Mailing Address - Phone:317-924-4009
Mailing Address - Fax:317-926-8410
Practice Address - Street 1:3520 GUION RD
Practice Address - Street 2:SUITE 301
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1692
Practice Address - Country:US
Practice Address - Phone:317-924-4009
Practice Address - Fax:317-926-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN823980Medicare ID - Type Unspecified
INCI4611Medicare PIN