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NPI Code Detail

MEDICARE: BRANNON WALSMITH HART HSPP

MEDICARE: BRANNON WALSMITH HART HSPP
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
1103TH0100XHealth Service Psychologist20043107AIN

General Provider Information

NPI Number : 1750885505
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANNON WALSMITH HART HSPP
Provider Business Mailing Address
First Line : 1503 N MITTHOEFFER RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46229-2425
Country : US
Telephone Number : 317-934-0800
Fax Number : 317-355-6150
Provider Business Practice Location Address
First Line : 5317 E 16TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46218-4897
Country : US
Telephone Number : 317-355-3700
Fax Number : 317-355-7793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2018
Last Update Date : 03/19/2018

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Directions to “ BRANNON WALSMITH HART HSPP” Practice Location

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