Healthcare Provider Details

I. General information

NPI: 1699656108
Provider Name (Legal Business Name): BROAD RIPPLE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6527 CARROLLTON AVE
INDIANAPOLIS IN
46220-1664
US

IV. Provider business mailing address

6926 DOVER RD
INDIANAPOLIS IN
46220-3822
US

V. Phone/Fax

Practice location:
  • Phone: 317-881-8737
  • Fax: 317-875-3993
Mailing address:
  • Phone: 317-881-8737
  • Fax: 317-875-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LINAMOR PARR
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 317-460-4846