MEDICARE: SHALOM HEALTH CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	363LP0200X	Pediatric Nurse Practitioner
3	363LF0000X	Family Nurse Practitioner
4	207Q00000X	Family Medicine Physician
5	363AM0700X	Medical Physician Assistant
6	207R00000X	Internal Medicine Physician
7	363A00000X	Physician Assistant
8	2084P0800X	Psychiatry Physician
9	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1982242327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALOM HEALTH CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	3400 LAFAYETTE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 LAFAYETTE RD
Second Line	:	MOBILE UNIT
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1146
Country	:	US
Telephone Number	:	317-291-7422
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. LEONARDO R ORTEGA
Credential	:	MD, MPH
Telephone Number	:	317-291-7422

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	03/30/2026

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