Healthcare Provider Details

I. General information

NPI: 1396992921
Provider Name (Legal Business Name): SURGERY CENTER PLUS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 N SHADELAND AVE SUITE 100
INDIANAPOLIS IN
46250-2036
US

IV. Provider business mailing address

7430 N SHADELAND AVE SUITE 100
INDIANAPOLIS IN
46250-2036
US

V. Phone/Fax

Practice location:
  • Phone: 317-841-4040
  • Fax: 317-577-7538
Mailing address:
  • Phone: 317-841-4141
  • Fax: 317-577-7538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01026265
License Number StateIN

VIII. Authorized Official

Name: JANICE C HOLMGREN
Title or Position: ADMINISTRATOR
Credential: R
Phone: 317-841-4141