MEDICARE: IVF INDIANA, 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	261QA0006X	Ambulatory Fertility Facility

General Provider Information

NPI Number	:	1720423734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVF INDIANA, LLC

Provider Business Mailing Address
First Line	:	10610 N PENNSYLVANIA ST
Second Line	:	SUITE 201
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-2004
Country	:	US
Telephone Number	:	317-575-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	10610 N PENNSYLVANIA ST
Second Line	:	SUITE 201
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-2004
Country	:	US
Telephone Number	:	317-575-6565
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOHN CROW JARRETT II
Credential	:	M.D.
Telephone Number	:	317-575-6565

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	05/03/2013

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