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General NPI Number Information
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NPI Number | 1851620801
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Entity Type | Organization
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Legal Business Name | INDIANAPOLIS NEUROSURGICAL GROUP
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 535 BARNHILL DR RT, 2ND FLOOR
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5116
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Country | US
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Telephone | 317-274-8111
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Fax | 317-278-3185
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Provider Business Mailing Address
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Address Line | 8333 NAAB RD SUITE 255
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-5924
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Country | US
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Telephone | 317-396-1300
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Fax | 317-396-1346
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | DEREK CANTRELL
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Credential | CFO
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Telephone | 317-396-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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