MEDICARE: RICHARD L. ROUDEBUSH VA MEDICAL CENTER

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	286500000X	Military Hospital

General Provider Information

NPI Number	:	1679687503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD L. ROUDEBUSH VA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	12306 BLUE SPRINGS LN
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-4053
Country	:	US
Telephone Number	:	317-576-9867
Fax Number	:

Provider Business Practice Location Address
First Line	:	3602 E MICHIGAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3466
Country	:	US
Telephone Number	:	317-988-2623
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MS. NICOLE MADOU
Credential	:	MSW
Telephone Number	:	317-988-2623

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/22/2020

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