MEDICARE: CIRCLE CITY PREP

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1386380483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLE CITY PREP

Provider Business Mailing Address
First Line	:	4002 N FRANKLIN RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-5297
Country	:	US
Telephone Number	:	317-643-4209
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 N FRANKLIN RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-5297
Country	:	US
Telephone Number	:	317-643-4209
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	COURTNEY ECKERLE
Credential	:
Telephone Number	:	317-643-4209

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	05/11/2022

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Directions to “CIRCLE CITY PREP ” Practice Location

Language	Start Address	Practice Location

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