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General NPI Number Information
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NPI Number | 1205801461
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Entity Type | Organization
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Legal Business Name | EASTERN INDIANA CENTER FOR AMBULATORY SURGERY LLC
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1350 CHESTER BLVD
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City | RICHMOND
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State | IN
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Zip | 47374-1907
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Country | US
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Telephone | 765-939-1351
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 CHESTER BLVD
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City | RICHMOND
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State | IN
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Zip | 47374-1907
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Country | US
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Telephone | 765-939-1351
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOSEPH M SMITH
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Credential | M.D.
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Telephone | 765-939-1351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | IN
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