Healthcare Provider Details

I. General information

NPI: 1033222633
Provider Name (Legal Business Name): COLON & RECTAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 N SHADELAND AVE COLON & RECTAL CARE SUITE 200
INDIANAPOLIS IN
46250
US

IV. Provider business mailing address

7430 N SHADELAND AVE COLON & RECTAL CARE SUITE 200
INDIANAPOLIS IN
46250
US

V. Phone/Fax

Practice location:
  • Phone: 317-841-8090
  • Fax: 317-577-7538
Mailing address:
  • Phone: 317-841-8090
  • Fax: 317-577-7538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number50002167A
License Number StateIN

VIII. Authorized Official

Name: SUSIE HANSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 317-841-8090