MEDICARE: LAUREN P. JACOBS MD

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	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	01086149A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568881506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN P. JACOBS MD

Provider Business Mailing Address
First Line	:	PO BOX 1026
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-1026
Country	:	US
Telephone Number	:	317-777-6435
Fax Number	:	317-777-6644

Provider Business Practice Location Address
First Line	:	705 RILEY HOSPITAL DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5109
Country	:	US
Telephone Number	:	317-962-3400
Fax Number	:	317-944-0208

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	07/15/2021

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Directions to “ LAUREN P. JACOBS MD” Practice Location

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