MEDICARE: METHODIST MEDICAL GROUP PHYSICIANS INC

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	207Q00000X	Family Medicine Physician		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285673616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST MEDICAL GROUP PHYSICIANS INC

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:	317-962-4836
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 N MERIDIAN ST
Second Line	:	STE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1077
Country	:	US
Telephone Number	:	317-962-4836
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN H POLLOM
Credential	:	MD
Telephone Number	:	317-962-1773

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	02/16/2012

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