Provider Demographics
NPI:1861657256
Name:INDIANA ENDOSCOPY CENTERS LLC
Entity Type:Organization
Organization Name:INDIANA ENDOSCOPY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-962-5660
Mailing Address - Street 1:1801 N SENATE BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1228
Mailing Address - Country:US
Mailing Address - Phone:317-962-5660
Mailing Address - Fax:
Practice Address - Street 1:10967 ALLISONVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2630
Practice Address - Country:US
Practice Address - Phone:317-962-5660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08-006221-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200893990CMedicaid
ZJ0010OtherMEDICARE PTAN