MEDICARE: BELTWAY SURGERY CENTERS, 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	261QA1903X	Ambulatory Surgical Clinic/Center	17-004756-1	IN

General Provider Information

NPI Number	:	1386159853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELTWAY SURGERY CENTERS, LLC

Provider Business Mailing Address
First Line	:	151 PENNSYLVANIA PKWY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-1379
Country	:	US
Telephone Number	:	317-817-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6850 PARKDALE PL
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4670
Country	:	US
Telephone Number	:	317-329-7222
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JON SCHAEFER
Credential	:
Telephone Number	:	317-814-1450

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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