Healthcare Provider Details

I. General information

NPI: 1306942859
Provider Name (Legal Business Name): CPN GENERAL SURGICAL CARE SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E COUNTY LINE RD SUITE 201
GREENWOOD IN
46143-1072
US

IV. Provider business mailing address

701 E COUNTY LINE RD SUITE 201
GREENWOOD IN
46143-1072
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-8000
  • Fax: 317-865-8012
Mailing address:
  • Phone: 317-865-8000
  • Fax: 317-865-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN J O'NEIL
Title or Position: SURGEON
Credential: MD
Phone: 317-865-8000