Healthcare Provider Details

I. General information

NPI: 1659512796
Provider Name (Legal Business Name): SOUTH INDY FAMILY PRACTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 E STOP 11 RD
INDIANAPOLIS IN
46237-8616
US

IV. Provider business mailing address

5545 E STOP 11 RD
INDIANAPOLIS IN
46237-8616
US

V. Phone/Fax

Practice location:
  • Phone: 317-884-2000
  • Fax: 317-884-2010
Mailing address:
  • Phone: 317-884-2000
  • Fax: 317-884-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number01042919A
License Number StateIN

VIII. Authorized Official

Name: DR. PATRICIA MARIE ENGLISH
Title or Position: PRESIDENT
Credential: MD
Phone: 317-884-2000