Healthcare Provider Details

I. General information

NPI: 1366934242
Provider Name (Legal Business Name): PROACTIVE CLINICAL PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 12/19/2025
Certification Date: 03/01/2021
Deactivation Date: 10/10/2025
Reactivation Date: 12/19/2025

III. Provider practice location address

2485 DIRECTORS ROW STE D
INDIANAPOLIS IN
46241-4907
US

IV. Provider business mailing address

2445 DIRECTORS ROW STE C
INDIANAPOLIS IN
46241-4936
US

V. Phone/Fax

Practice location:
  • Phone: 317-941-7338
  • Fax:
Mailing address:
  • Phone: 317-941-7338
  • Fax: 317-969-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW BRANDON HUNT
Title or Position: PRESIDENT
Credential: REGISTERED NURSE
Phone: 317-941-7338