Healthcare Provider Details

I. General information

NPI: 1326046822
Provider Name (Legal Business Name): SOUTH EMERSON SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8141 S EMERSON AVE SUITE C
INDIANAPOLIS IN
46237-8560
US

IV. Provider business mailing address

8141 S. EMERSON AVENUE
INDIANAPOLIS IN
46237
US

V. Phone/Fax

Practice location:
  • Phone: 317-888-1051
  • Fax:
Mailing address:
  • Phone: 317-888-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY A FOOTE
Title or Position: ADMINSTRATOR
Credential:
Phone: 317-888-1051