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General NPI Number Information
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NPI Number | 1982463600
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Entity Type | Organization
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Legal Business Name | PHYSICIAN PROVIDER SERVICES LLC
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 900 N HIGH SCHOOL RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-3759
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Country | US
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Telephone | 800-526-6797
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Fax |
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Provider Business Mailing Address
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Address Line | 1 INDIANA SQ STE 2060
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-2020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANDRE CREESE
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Credential |
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Telephone | 317-672-8600
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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