Healthcare Provider Details

I. General information

NPI: 1205939345
Provider Name (Legal Business Name): BELTWAY SURGERY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 HARCOURT RD
INDIANAPOLIS IN
46260-2046
US

IV. Provider business mailing address

200 W. 103RD STREET SUITE 2075
INDIANAPOLIS IN
46290-1020
US

V. Phone/Fax

Practice location:
  • Phone: 317-875-9105
  • Fax: 317-875-8638
Mailing address:
  • Phone: 317-817-1450
  • Fax: 317-875-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number13-005400-1
License Number StateIN

VIII. Authorized Official

Name: MR. ROBERT BOEGLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 317-817-1456