Provider Demographics
NPI:1205955119
Name:TOWER SURGICAL, INC
Entity type:Organization
Organization Name:TOWER SURGICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MICON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-923-7211
Mailing Address - Street 1:1801 SENATE BLVD
Mailing Address - Street 2:SUITE 635
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1228
Mailing Address - Country:US
Mailing Address - Phone:317-923-7211
Mailing Address - Fax:317-924-9682
Practice Address - Street 1:1801 N. SENATE BLVD.
Practice Address - Street 2:SUITE 635
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-923-7211
Practice Address - Fax:317-924-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200014350Medicaid
IN200014350Medicaid
IN222050Medicare PIN