Healthcare Provider Details

I. General information

NPI: 1700818598
Provider Name (Legal Business Name): BIDDINGER MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 SHORE DR SUITE 301
INDIANAPOLIS IN
46254-5621
US

IV. Provider business mailing address

3850 SHORE DR SUITE 301
INDIANAPOLIS IN
46254-5621
US

V. Phone/Fax

Practice location:
  • Phone: 317-387-0602
  • Fax: 317-387-0607
Mailing address:
  • Phone: 317-387-0602
  • Fax: 317-387-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DANA M MATTHEWS
Title or Position: PRESIDENT
Credential:
Phone: 317-387-0602