MEDICARE: SAMUEL MYERS

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	363AM0700X	Medical Physician Assistant	10002118A	IN

General Provider Information

NPI Number	:	1780131862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL MYERS

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 E COUNTY LINE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0963
Country	:	US
Telephone Number	:	316-887-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	01/22/2026

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Directions to “ SAMUEL MYERS ” Practice Location

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