Provider Demographics
NPI:1831350701
Name:GRACE SURGICAL PC
Entity type:Organization
Organization Name:GRACE SURGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-218-2813
Mailing Address - Street 1:8925 N MERIDIAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2386
Mailing Address - Country:US
Mailing Address - Phone:317-218-2813
Mailing Address - Fax:800-985-1194
Practice Address - Street 1:355 WESTFIELD RD
Practice Address - Street 2:SUITE 120
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1443
Practice Address - Country:US
Practice Address - Phone:317-770-5842
Practice Address - Fax:317-770-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty