MEDICARE: AFC PHYSICIANS OF INDIANA PC

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	208D00000X	General Practice Physician		IN

General Provider Information

NPI Number	:	1518326248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFC PHYSICIANS OF INDIANA PC

Provider Business Mailing Address
First Line	:	3700 CAHABA BEACH RD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-5225
Country	:	US
Telephone Number	:	205-403-8902
Fax Number	:	205-421-2109

Provider Business Practice Location Address
First Line	:	7411 N. KEYSTONE AVE.
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-3375
Country	:	US
Telephone Number	:	317-259-4616
Fax Number	:	317-259-4672

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RANDY JOHANSEN
Credential	:
Telephone Number	:	205-403-8902

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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