MEDICARE: MERCHO ROUSHDI DILLEY JACOB THORACOVASCULAR CORPORTATION

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	174400000X	Specialist

General Provider Information

NPI Number	:	1407958374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCHO ROUSHDI DILLEY JACOB THORACOVASCULAR CORPORTATION

Provider Business Mailing Address
First Line	:	1315 N ARLINGTON AVE STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3200
Country	:	US
Telephone Number	:	317-353-9338
Fax Number	:	317-355-9672

Provider Business Practice Location Address
First Line	:	1315 N ARLINGTON AVE STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3200
Country	:	US
Telephone Number	:	317-353-9338
Fax Number	:	317-355-9672

Authorized Official
Title or Position	:	CLINIC MANAGER
Name	:	MRS. SYLVIA E SCHOFIELD
Credential	:
Telephone Number	:	317-322-2390

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	09/04/2009

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