Healthcare Provider Details

I. General information

NPI: 1659275675
Provider Name (Legal Business Name): CAPITOL AVENUE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 N CAPITOL AVE
INDIANAPOLIS IN
46202-1221
US

IV. Provider business mailing address

2007 N CAPITOL AVE
INDIANAPOLIS IN
46202-1221
US

V. Phone/Fax

Practice location:
  • Phone: 317-450-5441
  • Fax: 317-920-0476
Mailing address:
  • Phone: 317-450-5441
  • Fax: 317-920-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRANDON EHRET EHRET
Title or Position: COO
Credential:
Phone: 317-450-5441