1194742551 NPI number — INDIANAPOLIS NEUROSURGICAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194742551 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:
1194742551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2009
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:
STE 255
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:
8051 S EMERSON AVE
Provider Second Line Business Practice Location Address:
STE 380
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46237-8600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-396-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANTRELL
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
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: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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