MEDICARE: KENDRICK REGIONAL CENTER FOR COLON AND RECTAL CARE

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	50003908A	IN

General Provider Information

NPI Number	:	1568549012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENDRICK REGIONAL CENTER FOR COLON AND RECTAL CARE

Provider Business Mailing Address
First Line	:	1215 HADLEY RD
Second Line	:	SUITE 201
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-2905
Country	:	US
Telephone Number	:	317-834-2020
Fax Number	:	317-831-9467

Provider Business Practice Location Address
First Line	:	1215 HADLEY RD
Second Line	:	SUITE 201
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-2905
Country	:	US
Telephone Number	:	317-834-2020
Fax Number	:	317-831-9467

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SUE CURTIS
Credential	:
Telephone Number	:	317-834-5867

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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Directions to “KENDRICK REGIONAL CENTER FOR COLON AND RECTAL CARE ” Practice Location

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