MEDICARE: SERVANT EXPRESS 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	207Q00000X	Family Medicine Physician
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1396437141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVANT EXPRESS CARE, LLC

Provider Business Mailing Address
First Line	:	2346 S LYNHURST DR STE E109
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-5169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2346 S LYNHURST DR STE E107
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-5169
Country	:	US
Telephone Number	:	317-688-8061
Fax Number	:	317-688-8064

Authorized Official
Title or Position	:	MEMBER
Name	:	DUANESHA POTTER
Credential	:	NP
Telephone Number	:	317-480-0415

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	06/06/2025

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