Healthcare Provider Details

I. General information

NPI: 1023373834
Provider Name (Legal Business Name): MIDWEST SPECIALTY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2012
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 GATWICK DR. SUITE 100
INDIANAPOLIS IN
46241-9506
US

IV. Provider business mailing address

14201 DALLAS PKWY
DALLAS TX
75254-2916
US

V. Phone/Fax

Practice location:
  • Phone: 317-821-0000
  • Fax: 317-821-0965
Mailing address:
  • Phone: 317-821-0000
  • Fax: 317-821-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER HARTSHORN
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 314-800-2017