Healthcare Provider Details

I. General information

NPI: 1861296964
Provider Name (Legal Business Name): HRT IN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9761 CROSSPOINT BLVD STE 500
INDIANAPOLIS IN
46256-3800
US

IV. Provider business mailing address

10501 W GOWAN RD STE 200
LAS VEGAS NV
89129-6602
US

V. Phone/Fax

Practice location:
  • Phone: 317-516-5172
  • Fax:
Mailing address:
  • Phone: 725-204-6055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WILKINSON
Title or Position: BUSINESS OPERATIONS DIRECTOR
Credential:
Phone: 725-204-6055