MEDICARE: INDIANAPOLIS NEUROSURGICAL GROUP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1023035482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANAPOLIS NEUROSURGICAL GROUP PC

Provider Business Mailing Address
First Line	:	1051 S GREENWOOD SPRINGS BLVD
Second Line	:	SUITE 201
City	:	GREENWOOD
State	:	IN
Zip	:	46143-6479
Country	:	US
Telephone Number	:	317-396-1300
Fax Number	:	317-396-1346

Provider Business Practice Location Address
First Line	:	1051 S GREENWOOD SPRINGS BLVD
Second Line	:	SUITE 210
City	:	GREENWOOD
State	:	IN
Zip	:	46143-6479
Country	:	US
Telephone Number	:	317-396-1300
Fax Number	:	317-396-1346

Authorized Official
Title or Position	:	CFO
Name	:	DEREK CANTRELL
Credential	:
Telephone Number	:	317-396-1386

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	06/04/2015

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