Provider Demographics
NPI:1053108860
Name:MINGS, JUSTIN SCOTT
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SCOTT
Last Name:MINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 E 750 S
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:IN
Mailing Address - Zip Code:47234-9751
Mailing Address - Country:US
Mailing Address - Phone:317-364-0135
Mailing Address - Fax:
Practice Address - Street 1:1561 E 750 S
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:IN
Practice Address - Zip Code:47234-9751
Practice Address - Country:US
Practice Address - Phone:317-364-0135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant