MEDICARE: SYCAMORE SPRINGS SURGERY CENTER, LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center		IN

General Provider Information

NPI Number	:	1700881745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYCAMORE SPRINGS SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	4715 STATESMEN DR
Second Line	:	STE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1997
Country	:	US
Telephone Number	:	317-284-5288
Fax Number	:	317-284-5295

Provider Business Practice Location Address
First Line	:	4715 STATESMEN DR
Second Line	:	STE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1997
Country	:	US
Telephone Number	:	317-284-5288
Fax Number	:	317-284-5295

Authorized Official
Title or Position	:	CEO
Name	:	DR. PATRICK A DEHEER
Credential	:	DPM
Telephone Number	:	800-615-1363

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/22/2020

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