Healthcare Provider Details

I. General information

NPI: 1619168713
Provider Name (Legal Business Name): PHYSICIAN ASSISTANT SURGICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12360 CREEKWOOD LN
CARMEL IN
46032-8287
US

IV. Provider business mailing address

12360 CREEKWOOD LN
CARMEL IN
46032-8287
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-0852
  • Fax:
Mailing address:
  • Phone: 317-844-0852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH H SCHMIDT
Title or Position: DIRECTOR
Credential: PA-C
Phone: 317-844-0852