Provider Demographics
NPI:1740472943
Name:CENTRAL INDIANA PET, LLC
Entity type:Organization
Organization Name:CENTRAL INDIANA PET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KLAVON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-338-6384
Mailing Address - Street 1:8402 HARCOURT RD
Mailing Address - Street 2:SUITE 721
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2074
Mailing Address - Country:US
Mailing Address - Phone:317-338-6384
Mailing Address - Fax:317-338-6385
Practice Address - Street 1:8402 HARCOURT RD
Practice Address - Street 2:SUITE 721
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2074
Practice Address - Country:US
Practice Address - Phone:317-338-6384
Practice Address - Fax:317-338-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201930Medicare UPIN