MEDICARE: INDIANA MATH AND SCIENCE ACADEMY SOUTH

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	:	1982022612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA MATH AND SCIENCE ACADEMY SOUTH

Provider Business Mailing Address
First Line	:	2710 BETHEL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-3103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 BETHEL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-3103
Country	:	US
Telephone Number	:	317-780-1200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CATHY SPARKS
Credential	:
Telephone Number	:	317-780-1200

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	03/31/2014

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