MEDICARE: KIPP INDIANAPOLIS, INC

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1760166219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIPP INDIANAPOLIS, INC

Provider Business Mailing Address
First Line	:	1740 E 30TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-2605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 E 30TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-2605
Country	:	US
Telephone Number	:	317-547-5477
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS OPERATIONS
Name	:	BRITTANY LENNON
Credential	:
Telephone Number	:	317-775-3929

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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