Provider Demographics
NPI:1700881745
Name:SYCAMORE SPRINGS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SYCAMORE SPRINGS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEHEER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:800-615-1363
Mailing Address - Street 1:4715 STATESMEN DR
Mailing Address - Street 2:STE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1997
Mailing Address - Country:US
Mailing Address - Phone:317-284-5288
Mailing Address - Fax:317-284-5295
Practice Address - Street 1:4715 STATESMEN DR
Practice Address - Street 2:STE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1997
Practice Address - Country:US
Practice Address - Phone:317-284-5288
Practice Address - Fax:317-284-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical