1942376926 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 1942376926 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:
Provider Other Organization Name Type Code:
6
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:
1942376926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2014
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:
2525 W UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 503
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47303-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-288-0441
Provider Business Practice Location Address Fax Number:
765-282-7879
Provider Enumeration Date:
11/28/2006

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:
317-396-1386

Provider Taxonomy Codes

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

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

  • Identifier: 200235010A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200971560N , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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