Provider Demographics
NPI:1275667677
Name:WOUND CARE SPECIALISTS OF INDIANA PC
Entity Type:Organization
Organization Name:WOUND CARE SPECIALISTS OF INDIANA PC
Other - Org Name:JODIE R. HARPER, MD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-796-3897
Mailing Address - Street 1:1200 W CARMEL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8707
Mailing Address - Country:US
Mailing Address - Phone:800-927-6316
Mailing Address - Fax:888-505-6818
Practice Address - Street 1:1200 W CARMEL DR STE 103
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8707
Practice Address - Country:US
Practice Address - Phone:800-927-6316
Practice Address - Fax:888-505-6818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004699A207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200361260Medicaid
IN000000368687OtherANTHEM GROUP NUMBER
IN1003817297OtherNPI
1275667677OtherNPI - GROUP
IN200361260Medicaid