Healthcare Provider Details

I. General information

NPI: 1376368985
Provider Name (Legal Business Name): IJRI NOBLESVILLE ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14065 BORGWARNER DR
NOBLESVILLE IN
46060-9448
US

IV. Provider business mailing address

3834 S EMERSON AVE STE A
INDIANAPOLIS IN
46203-5902
US

V. Phone/Fax

Practice location:
  • Phone: 317-620-0232
  • Fax: 260-208-9561
Mailing address:
  • Phone: 317-620-0232
  • Fax: 260-208-9561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT M MENEGHINI
Title or Position: CEO
Credential: MD
Phone: 317-620-0232