Provider Demographics
NPI:1265527329
Name:GIVENS, STANLEY SCOT (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:SCOT
Last Name:GIVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 W 96TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6005
Mailing Address - Country:US
Mailing Address - Phone:317-715-1800
Mailing Address - Fax:317-715-6200
Practice Address - Street 1:8244 EAST US 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123
Practice Address - Country:US
Practice Address - Phone:317-272-3636
Practice Address - Fax:317-272-3646
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010366672085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01036667BOtherCSR
IN100062700Medicaid
IN200259350Medicaid
IN200259350Medicaid
IN01036667BOtherCSR
IN366480BMedicare PIN
INBG1980045OtherDEA
IN677730GGGMedicare PIN
INP00480010Medicare PIN
IN200259350Medicaid
IN149720FFMedicare PIN