Healthcare Provider Details

I. General information

NPI: 1083688600
Provider Name (Legal Business Name): GREENWOOD ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E COUNTY LINE RD SUITE 200
INDIANAPOLIS IN
46227
US

IV. Provider business mailing address

1550 E COUNTY LINE RD SUITE 200
INDIANAPOLIS IN
46227
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-6497
  • Fax: 317-497-6400
Mailing address:
  • Phone: 317-497-6497
  • Fax: 317-497-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD W JACKSON
Title or Position: PHYSICIAN OWNER OF PRACTICE
Credential: MD
Phone: 317-497-6497