1316276363 NPI number — INDIANAPOLIS NEUROSURGICAL GROUP

Table of content: (NPI 1316276363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316276363 NPI number — INDIANAPOLIS NEUROSURGICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANAPOLIS NEUROSURGICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOODMAN CAMPBELL BRAIN AND SPINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316276363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8333 NAAB RD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-5924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-396-1300
Provider Business Mailing Address Fax Number:
317-396-1346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1115 RONALD REAGAN PKWY
Provider Second Line Business Practice Location Address:
SUITE 148
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46123-6910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-278-3200
Provider Business Practice Location Address Fax Number:
317-278-3333
Provider Enumeration Date:
12/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CANTRELL
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
317-396-1300

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100318390 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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