Provider Demographics
NPI:1891795084
Name:CIRCLE CITY MEDICAL GROUP
Entity Type:Organization
Organization Name:CIRCLE CITY MEDICAL GROUP
Other - Org Name:SMARTT NEUROLOGY, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL PRACTICE MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-865-9824
Mailing Address - Street 1:9640 N AUGUSTA DR
Mailing Address - Street 2:SUITE 412
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9600
Mailing Address - Country:US
Mailing Address - Phone:317-872-4545
Mailing Address - Fax:317-872-3959
Practice Address - Street 1:9640 N AUGUSTA DR
Practice Address - Street 2:SUITE 412
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9600
Practice Address - Country:US
Practice Address - Phone:317-872-4545
Practice Address - Fax:317-872-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058330A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI21963Medicare UPIN