Provider Demographics
NPI:1205939345
Name:BELTWAY SURGERY CENTERS LLC
Entity type:Organization
Organization Name:BELTWAY SURGERY CENTERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-817-1456
Mailing Address - Street 1:200 W. 103RD STREET
Mailing Address - Street 2:SUITE 2075
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1020
Mailing Address - Country:US
Mailing Address - Phone:317-817-1450
Mailing Address - Fax:317-875-8638
Practice Address - Street 1:8501 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2046
Practice Address - Country:US
Practice Address - Phone:317-875-9105
Practice Address - Fax:317-875-8638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAND SURGERY ASSOCIATES OF INDIANA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13-005400-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097860OtherANTHEM
IN201137250AMedicaid
ININ1237Medicare Oscar/Certification