Healthcare Provider Details

I. General information

NPI: 1053592568
Provider Name (Legal Business Name): SURGERY CENTER ANESTHESIOLOGISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13421 OLD MERIDIAN ST
CARMEL IN
46032-1427
US

IV. Provider business mailing address

PO BOX 68952
INDIANAPOLIS IN
46268-0952
US

V. Phone/Fax

Practice location:
  • Phone: 317-706-1600
  • Fax:
Mailing address:
  • Phone: 317-802-6400
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL N PAYNE
Title or Position: AUTHORIZED REP
Credential: MD
Phone: 317-235-8825