MEDICARE: JERRY L HOUSE MD

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	207Y00000X	Otolaryngology Physician	01025675A	IN
2	207YX0901X	Otology & Neurotology Physician	01025675A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000078907	OTHER	IN	ANTHEM BS

General Provider Information

NPI Number	:	1871688275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY L HOUSE MD

Provider Business Mailing Address
First Line	:	9002 N MERIDIAN ST
Second Line	:	SUITE 204
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5350
Country	:	US
Telephone Number	:	317-848-9505
Fax Number	:	317-848-3623

Provider Business Practice Location Address
First Line	:	9002 N MERIDIAN ST
Second Line	:	SUITE 204
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5350
Country	:	US
Telephone Number	:	317-848-9505
Fax Number	:	317-848-3623

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/11/2025

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Directions to “ JERRY L HOUSE MD” Practice Location

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