Healthcare Provider Details

I. General information

NPI: 1578561890
Provider Name (Legal Business Name): THE ENDOSCOPY CENTER AT ST. FRANCIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 150
INDIANAPOLIS IN
46237-8635
US

IV. Provider business mailing address

8051 S EMERSON AVE SUITE 150
INDIANAPOLIS IN
46237-8600
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-2955
  • Fax: 317-865-2952
Mailing address:
  • Phone: 317-865-2955
  • Fax: 317-865-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number05-008858-1
License Number StateIN

VIII. Authorized Official

Name: DR. LUCAS M DRAKE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 317-865-2955