MEDICARE: EAGLE CREEK URGENT CARE LLC

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1316715105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE CREEK URGENT CARE LLC

Provider Business Mailing Address
First Line	:	5645 LAFAYETTE RD STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-1103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5645 LAFAYETTE RD STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-1103
Country	:	US
Telephone Number	:	317-387-3050
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	JOSEPH CHRISTOPHER BRINKLEY
Credential	:
Telephone Number	:	317-387-3050

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	12/12/2023

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