Healthcare Provider Details

I. General information

NPI: 1194742551
Provider Name (Legal Business Name): INDIANAPOLIS NEUROSURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 380
INDIANAPOLIS IN
46237-8600
US

IV. Provider business mailing address

8333 NAAB RD STE 255
INDIANAPOLIS IN
46260-5924
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-1300
  • Fax:
Mailing address:
  • Phone: 317-396-1300
  • Fax: 317-396-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DEREK CANTRELL
Title or Position: CFO
Credential:
Phone: 317-396-1300