Healthcare Provider Details

I. General information

NPI: 1659984870
Provider Name (Legal Business Name): CENTRAL INDIANA VASCULAR CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 N EMERSON AVE STE F
GREENWOOD IN
46143-5676
US

IV. Provider business mailing address

853 N EMERSON AVE STE F
GREENWOOD IN
46143-5676
US

V. Phone/Fax

Practice location:
  • Phone: 317-868-7979
  • Fax:
Mailing address:
  • Phone: 317-868-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KARRI KING
Title or Position: OFFICIAL
Credential:
Phone: 727-214-0462