Healthcare Provider Details

I. General information

NPI: 1306079330
Provider Name (Legal Business Name): WHITEWATER SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CHESTER BLVD
RICHMOND IN
47374-1213
US

IV. Provider business mailing address

1900 CHESTER BLVD
RICHMOND IN
47374-1213
US

V. Phone/Fax

Practice location:
  • Phone: 765-966-1200
  • Fax: 765-962-1191
Mailing address:
  • Phone: 765-966-1200
  • Fax: 765-962-1191

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: DR. KEVIN T SCRIPTURE
Title or Position: PART OWNER/CEO
Credential: MD
Phone: 765-962-2020