MEDICARE: IRELAND HIP & KNEE SURGERY 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	207X00000X	Orthopaedic Surgery Physician	01025374A	IN

General Provider Information

NPI Number	:	1659406692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRELAND HIP & KNEE SURGERY PC

Provider Business Mailing Address
First Line	:	9302 N MERIDIAN ST
Second Line	:	SUITE 299
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1873
Country	:	US
Telephone Number	:	317-816-5611
Fax Number	:	317-816-5616

Provider Business Practice Location Address
First Line	:	9302 N MERIDIAN ST
Second Line	:	SUITE 299
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1873
Country	:	US
Telephone Number	:	317-816-5611
Fax Number	:	317-816-5616

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JANICE K BOLES
Credential	:	RN
Telephone Number	:	317-816-5614

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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