Provider Demographics
NPI:1891845103
Name:BROOKS, HUGH LAWRENCE (CRNA)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:LAWRENCE
Last Name:BROOKS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7150 CLEARVISTA DR
Practice Address - Street 2:FAMILY ROOMS
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1695
Practice Address - Country:US
Practice Address - Phone:317-621-5890
Practice Address - Fax:317-355-2205
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC213429367500000X
IN28181491A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000735774OtherANTHEM PROVIDER NUMBER FOR TIN 35-2030653
IN000000594858OtherANTHEM
IN200926410Medicaid
INM400057320Medicare PIN
IN000000735774OtherANTHEM PROVIDER NUMBER FOR TIN 35-2030653