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General NPI Number Information
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NPI Number | 1881319127
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Entity Type | Organization
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Legal Business Name | PRIME SURGERY CENTER
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 4715 STATESMEN DR STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-1997
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Country | US
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Telephone | 317-932-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 4715 STATESMEN DR. SUITE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-1997
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Country | US
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Telephone | 317-932-3411
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | DR. SAMIULLAH KUNDI
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Credential | M.D.
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Telephone | 405-408-6154
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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 |
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