Healthcare Provider Details

I. General information

NPI: 1083825616
Provider Name (Legal Business Name): INPATIENT SERVICES ASSOCIATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3589 LAFAYETTE PKWY
FLOYDS KNOBS IN
47119-9760
US

IV. Provider business mailing address

PO BOX 950238
LOUISVILLE KY
40295-0238
US

V. Phone/Fax

Practice location:
  • Phone: 812-949-6264
  • Fax: 812-949-5073
Mailing address:
  • Phone: 812-949-5077
  • Fax: 812-949-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01033730A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDD7199
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerRAIL ROAD MEDICARE
# 2
Identifier100086780
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name: DR. LYLE BEARD
Title or Position: OWNER
Credential: MD
Phone: 812-949-6264