MEDICARE: APP OF INDIANA ED, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1740822212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APP OF INDIANA ED, PLLC

Provider Business Mailing Address
First Line	:	5121 MARYLAND WAY STE 300
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 MARYLAND WAY STE 300
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7516
Country	:	US
Telephone Number	:	629-203-7320
Fax Number	:	629-216-0568

Authorized Official
Title or Position	:	CFO
Name	:	JAMES GRIMES
Credential	:
Telephone Number	:	855-246-8607

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	01/26/2023

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