Healthcare Provider Details

I. General information

NPI: 1811351778
Provider Name (Legal Business Name): OPIOID MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N STATE ROAD 135
GREENWOOD IN
46142-1314
US

IV. Provider business mailing address

821 N STATE ROAD 135
GREENWOOD IN
46142-1314
US

V. Phone/Fax

Practice location:
  • Phone: 317-560-4300
  • Fax: 317-530-9084
Mailing address:
  • Phone: 317-560-4300
  • Fax: 317-530-9084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SIMON FU FENG
Title or Position: OWNER
Credential:
Phone: 317-560-4300