Provider Demographics
NPI:1811019847
Name:UNIVERSITY GENERAL SURGEONS, INC.
Entity Type:Organization
Organization Name:UNIVERSITY GENERAL SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-278-7019
Mailing Address - Street 1:PO BOX 441727
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46244-1727
Mailing Address - Country:US
Mailing Address - Phone:317-278-7019
Mailing Address - Fax:317-481-1337
Practice Address - Street 1:5610 CRAWFORDSVILLE RD
Practice Address - Street 2:CORPORATE SQUARE WEST, BLDG. 10
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3727
Practice Address - Country:US
Practice Address - Phone:317-278-7019
Practice Address - Fax:317-481-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50002895A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN797470Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #