Healthcare Provider Details

I. General information

NPI: 1609323708
Provider Name (Legal Business Name): CARRIE B. BOYD HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 N TACOMA AVE 12
INDIANAPOLIS IN
46220-3512
US

IV. Provider business mailing address

PO BOX 7140
FISHERS IN
46038-7140
US

V. Phone/Fax

Practice location:
  • Phone: 317-501-0210
  • Fax:
Mailing address:
  • Phone: 317-501-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number02003708A
License Number StateIN

VIII. Authorized Official

Name: DR. CARLA V CORK
Title or Position: PHYSICIAN/OWNER
Credential: D.O., M.A.T.
Phone: 317-501-0210