Provider Demographics
NPI:1790083962
Name:MAJOR MULTISPECIALTY ASSOCIATES
Entity Type:Organization
Organization Name:MAJOR MULTISPECIALTY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-392-3211
Mailing Address - Street 1:275 WEST BASSETT ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8575
Mailing Address - Country:US
Mailing Address - Phone:317-421-3265
Mailing Address - Fax:317-398-1872
Practice Address - Street 1:275 WEST BASSETT ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8575
Practice Address - Country:US
Practice Address - Phone:317-421-3265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAJOR SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-11
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200941210Medicaid
IN200941210Medicaid
INH02055Medicare UPIN
IN5127180001Medicare NSC