Healthcare Provider Details

I. General information

NPI: 1689597759
Provider Name (Legal Business Name): EMMA RUTH HAMILTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 CLEARVISTA DR
INDIANAPOLIS IN
46256-1695
US

IV. Provider business mailing address

9218 SPRING ST
HIGHLAND IN
46322-2537
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-6262
  • Fax:
Mailing address:
  • Phone: 219-228-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: