Provider Demographics
NPI:1831436575
Name:CENTRAL INDIANA PODIATRY, PC
Entity type:Organization
Organization Name:CENTRAL INDIANA PODIATRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-931-0664
Mailing Address - Street 1:3731 GUION ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-7604
Mailing Address - Country:US
Mailing Address - Phone:317-931-0664
Mailing Address - Fax:317-927-0924
Practice Address - Street 1:7098 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4273
Practice Address - Country:US
Practice Address - Phone:317-842-7098
Practice Address - Fax:317-842-3999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL INDIANA PODIATRY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-15
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCK6005OtherPALMETTO GBA
INCK6005OtherPALMETTO GBA
IN4685310012Medicare NSC