Provider Demographics
NPI:1356533996
Name:ADULT MEDICINE CENTER
Entity type:Organization
Organization Name:ADULT MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORRISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-802-9912
Mailing Address - Street 1:8424 NAAB RD
Mailing Address - Street 2:SUITE 3P
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5918
Mailing Address - Country:US
Mailing Address - Phone:317-802-9912
Mailing Address - Fax:317-802-9924
Practice Address - Street 1:8424 NAAB RD
Practice Address - Street 2:SUITE 3P
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5918
Practice Address - Country:US
Practice Address - Phone:317-802-9912
Practice Address - Fax:317-802-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052737A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
209360AMedicare PIN
INH24077Medicare UPIN