MEDICARE: PRIME SURGERY CENTER

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1881319127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME SURGERY CENTER

Provider Business Mailing Address
First Line	:	4715 STATESMEN DR.
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1997
Country	:	US
Telephone Number	:	317-932-3411
Fax Number	:

Provider Business Practice Location Address
First Line	:	4715 STATESMEN DR STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1997
Country	:	US
Telephone Number	:	317-932-3411
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	DR. SAMIULLAH KUNDI
Credential	:	M.D.
Telephone Number	:	405-408-6154

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	12/12/2024

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Directions to “PRIME SURGERY CENTER ” Practice Location

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