MEDICARE: INDIANA PELVIC PAIN SPECIALISTS PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
2	225100000X	Physical Therapist
3	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1073257291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA PELVIC PAIN SPECIALISTS PC

Provider Business Mailing Address
First Line	:	985 DORMAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3570
Country	:	US
Telephone Number	:	317-288-1763
Fax Number	:	816-208-9047

Provider Business Practice Location Address
First Line	:	985 DORMAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3570
Country	:	US
Telephone Number	:	317-288-1763
Fax Number	:	816-208-9047

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	AMY DAWN MEDLEY
Credential	:	DPT
Telephone Number	:	812-891-3216

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	01/29/2024

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