Healthcare Provider Details

I. General information

NPI: 1598716524
Provider Name (Legal Business Name): MINDGENT HEALTHCARE CLINICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 N MERIDIAN ST SUITE 310
INDIANAPOLIS IN
46290-1151
US

IV. Provider business mailing address

10401 NORTH MERIDIAN STREET SUITE 310
INDIANAPOLIS IN
46290-1151
US

V. Phone/Fax

Practice location:
  • Phone: 317-428-4379
  • Fax: 317-574-0336
Mailing address:
  • Phone: 317-428-4379
  • Fax: 317-574-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIE BECKNER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 317-428-4370