MEDICARE: COMMUNITY PEDIATRIC CENTER

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1295715837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY PEDIATRIC CENTER

Provider Business Mailing Address
First Line	:	1515 N POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4213
Country	:	US
Telephone Number	:	317-898-5437
Fax Number	:	317-898-4970

Provider Business Practice Location Address
First Line	:	1515 N POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4213
Country	:	US
Telephone Number	:	317-898-5437
Fax Number	:	317-898-4970

Authorized Official
Title or Position	:	OFFICE COORDINATOR
Name	:	MS. PAM L. JENNINGS
Credential	:
Telephone Number	:	317-899-9588

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	08/22/2020

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