Provider Demographics
NPI:1851831630
Name:AMAZING GRACE MEDICAL CONSULTANTS, LLC
Entity Type:Organization
Organization Name:AMAZING GRACE MEDICAL CONSULTANTS, LLC
Other - Org Name:AMAZING GRACE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-735-1727
Mailing Address - Street 1:6349 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7107
Mailing Address - Country:US
Mailing Address - Phone:317-735-1727
Mailing Address - Fax:317-735-1837
Practice Address - Street 1:6349 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7107
Practice Address - Country:US
Practice Address - Phone:317-735-1727
Practice Address - Fax:317-735-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty