MEDICARE: DR. REBECCA R SMALL MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11291	NH
2	207Q00000X	Family Medicine Physician	01063143A	IN
3	208M00000X	Hospitalist Physician	01063143A	IN

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	:	1194720003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA R SMALL MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:	STE 130 - PROVIDER ENROLLMENT
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 UNIVERSITY BLVD
Second Line	:	UH 1501
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5149
Country	:	US
Telephone Number	:	317-948-0763
Fax Number	:	317-948-0503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/17/2014

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Directions to “ DR. REBECCA R SMALL MD” Practice Location

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