MEDICARE: SHALOM HEALTH CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	2084P0800X	Psychiatry Physician
3	363LF0000X	Family Nurse Practitioner
4	363LP0200X	Pediatric Nurse Practitioner
5	207Q00000X	Family Medicine Physician
6	207R00000X	Internal Medicine Physician
7	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003275512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALOM HEALTH CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	3400 LAFAYETTE RD STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1147
Country	:	US
Telephone Number	:	317-291-7422
Fax Number	:	317-291-4912

Provider Business Practice Location Address
First Line	:	5750 W 56TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-1695
Country	:	US
Telephone Number	:	317-291-7422
Fax Number	:	317-291-4912

Authorized Official
Title or Position	:	CEO/EXECUTIVE DIRECTOR
Name	:	LEONARDO R ORTEGA
Credential	:	M.D., M.P.H.
Telephone Number	:	317-291-7422

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	01/22/2021

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Directions to “SHALOM HEALTH CARE CENTER, INC. ” Practice Location

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