MEDICARE: BROAD RIPPLE PEDIATRICS, LLC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1699656108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROAD RIPPLE PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	6926 DOVER RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-3822
Country	:	US
Telephone Number	:	317-881-8737
Fax Number	:	317-875-3993

Provider Business Practice Location Address
First Line	:	6527 CARROLLTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1664
Country	:	US
Telephone Number	:	317-881-8737
Fax Number	:	317-875-3993

Authorized Official
Title or Position	:	PEDIATRICIAN
Name	:	DR. LINAMOR PARR
Credential	:	MD
Telephone Number	:	317-460-4846

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	09/10/2025

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