MEDICARE: EAST CAMPUS 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	080108171	IN

General Provider Information

NPI Number	:	1891935201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST CAMPUS SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	5445 E 16TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4869
Country	:	US
Telephone Number	:	317-355-7000
Fax Number	:	317-351-2428

Provider Business Practice Location Address
First Line	:	5445 E 16TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4869
Country	:	US
Telephone Number	:	317-355-7000
Fax Number	:	317-351-2428

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LORI WALTON
Credential	:
Telephone Number	:	317-355-7000

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	02/25/2009

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