Provider Demographics
NPI:1861679094
Name:INDIANA SPINE GROUP, PC
Entity Type:Organization
Organization Name:INDIANA SPINE GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-228-7000
Mailing Address - Street 1:13225 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5480
Mailing Address - Country:US
Mailing Address - Phone:317-228-7000
Mailing Address - Fax:317-228-2321
Practice Address - Street 1:821 N DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-1754
Practice Address - Country:US
Practice Address - Phone:765-450-0111
Practice Address - Fax:765-553-5504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA SPINE GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-30
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000214063OtherANTHEM GROUP NUMBER
IN200359410-CMedicaid
IN366735000OtherUS POSTAL SERVICE WORKERS
INCJ8084OtherMEDICARE RAILROAD
IN366735000OtherUS DEPARTMENT OF LABOR
IN200359410-CMedicaid
IN186950Medicare PIN
IN000000214063OtherANTHEM GROUP NUMBER