Healthcare Provider Details

I. General information

NPI: 1528473345
Provider Name (Legal Business Name): OBJECTIVE SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 NAAB RD SUITE 140
INDIANAPOLIS IN
46260-5925
US

IV. Provider business mailing address

8330 NAAB RD SUITE 140
INDIANAPOLIS IN
46260-5925
US

V. Phone/Fax

Practice location:
  • Phone: 800-639-5191
  • Fax: 855-809-9989
Mailing address:
  • Phone: 800-639-5191
  • Fax: 855-809-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateIN

VIII. Authorized Official

Name: NANCY GREGORI
Title or Position: CEO
Credential: R.N.
Phone: 800-639-5191