Healthcare Provider Details

I. General information

NPI: 1003573999
Provider Name (Legal Business Name): MIDWEST CENTER FOR PELVIC HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 91ST ST STE B
INDIANAPOLIS IN
46240-1570
US

IV. Provider business mailing address

PO BOX 80241
INDIANAPOLIS IN
46280-0241
US

V. Phone/Fax

Practice location:
  • Phone: 317-793-2819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAT BYRNES
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 949-615-9065