Healthcare Provider Details

I. General information

NPI: 1528085974
Provider Name (Legal Business Name): INDIANAPOLIS NEUROSURGICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 CLEARVISTA DR SUITE 3100
INDIANAPOLIS IN
46256-1621
US

IV. Provider business mailing address

13345 ILLINOIS ST
CARMEL IN
46032-3318
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-1300
  • Fax: 317-396-1468
Mailing address:
  • Phone: 317-396-1462
  • Fax: 317-396-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DEREK CANTRELL
Title or Position: CFO
Credential:
Phone: 317-396-1386