MEDICARE: HEDGEHOG PSYCHIATRIC

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	1041C0700X	Clinical Social Worker	34003324A	IN
2	364S00000X	Clinical Nurse Specialist	71000401A	IN
3	364S00000X	Clinical Nurse Specialist	70000131A	IN

General Provider Information

NPI Number	:	1093760951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEDGEHOG PSYCHIATRIC

Provider Business Mailing Address
First Line	:	8563 ZIONSVILLE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1511
Country	:	US
Telephone Number	:	317-337-9967
Fax Number	:	317-337-9968

Provider Business Practice Location Address
First Line	:	8563 ZIONSVILLE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1511
Country	:	US
Telephone Number	:	317-337-9967
Fax Number	:	317-337-9968

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MRS. PENNI FUQUA
Credential	:
Telephone Number	:	317-337-9967

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	11/19/2007

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