MEDICARE: EVOLVE HEALTH CLINIC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1528912359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE HEALTH CLINIC

Provider Business Mailing Address
First Line	:	10721 CRELL CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-9770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10721 CRELL CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-9770
Country	:	US
Telephone Number	:	317-640-3308
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHAWNTA CRAYTON
Credential	:
Telephone Number	:	317-640-3308

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	03/20/2026

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