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NPI Code Detail

MEDICARE: MR. BRENT JUSTIN AMBLER PA-C

MEDICARE:  MR. BRENT JUSTIN AMBLER  PA-C
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
1363A00000XPhysician Assistant10000969AIN

General Provider Information

NPI Number : 1417133497
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRENT JUSTIN AMBLER PA-C
Provider Business Mailing Address
First Line : 8402 HARCOURT RD STE 125
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2094
Country : US
Telephone Number : 317-802-2000
Fax Number : 317-802-3972
Provider Business Practice Location Address
First Line : 8402 HARCOURT RD STE 125
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2094
Country : US
Telephone Number : 317-802-2000
Fax Number : 317-802-3972
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2008
Last Update Date : 04/14/2026

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Directions to “ MR. BRENT JUSTIN AMBLER PA-C” Practice Location

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