Provider Demographics
NPI:1295718583
Name:MAPLETON WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:MAPLETON WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARTER-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-927-2168
Mailing Address - Street 1:3363 N PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3415
Mailing Address - Country:US
Mailing Address - Phone:317-927-2168
Mailing Address - Fax:317-927-2811
Practice Address - Street 1:3363 N PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3415
Practice Address - Country:US
Practice Address - Phone:317-927-2168
Practice Address - Fax:317-927-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN207510Medicare ID - Type Unspecified