Basic Information
| Provider Information | |||||||||
| NPI: | 1174636237 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHEAST SURGERY CENTER LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INDIANA ORTHOPAEDIC SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5255 E STOP 11 RD | ||||||||
| Address2: | # 110 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462376340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178845200 | ||||||||
| FaxNumber: | 3178845360 | ||||||||
| Practice Location | |||||||||
| Address1: | 5255 E STOP 11 RD | ||||||||
| Address2: | # 110 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462376340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178845200 | ||||||||
| FaxNumber: | 3178845360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 02/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | KELLER | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3178022000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.