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General NPI Number Information
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NPI Number | 1134292832
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Entity Type | Organization
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Legal Business Name | INDIANA URGENT CARE CENTERS, LLC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3479 W 86TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-1948
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Country | US
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Telephone | 317-471-0001
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Fax | 317-471-0002
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Provider Business Mailing Address
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Address Line | 3479 W 86TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-1948
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Country | US
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Telephone | 317-471-0001
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Fax | 317-471-0002
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | E. STANLEY KARDATZKE
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Credential | M.D.
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Telephone | 317-471-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 01053617A
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License Number State | IN
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