Healthcare Provider Details

I. General information

NPI: 1134954647
Provider Name (Legal Business Name): IES HSP INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 W JEFFERSON ST
FRANKLIN IN
46131-2140
US

IV. Provider business mailing address

PO BOX 3205
INDIANAPOLIS IN
46206-3205
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: NESTOR ZENAROSA
Title or Position: AO/OWNER
Credential: MD
Phone: 469-420-5544