Provider Demographics
NPI:1922345669
Name:CENTRAL INDIANA PODIATRY, PC
Entity Type:Organization
Organization Name:CENTRAL INDIANA PODIATRY, PC
Other - Org Name:ACHILLES PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-931-0664
Mailing Address - Street 1:3731 GUION ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-7604
Mailing Address - Country:US
Mailing Address - Phone:317-931-0664
Mailing Address - Fax:317-927-0924
Practice Address - Street 1:1720 LAFAYETTE ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4604
Practice Address - Country:US
Practice Address - Phone:765-362-6233
Practice Address - Fax:765-362-8270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL INDIANA PODIATRY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-15
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCK6005OtherPALMETTO GBA
IN4685310010Medicare NSC
INCK6005OtherPALMETTO GBA