Provider Demographics
NPI:1659557437
Name:MED SURG PLUS PC
Entity Type:Organization
Organization Name:MED SURG PLUS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-962-0913
Mailing Address - Street 1:100 N 15TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 N 15TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4355
Practice Address - Country:US
Practice Address - Phone:765-962-0913
Practice Address - Fax:765-962-8745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040839261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN906050Medicare PIN
F39115Medicare UPIN