Basic Information
| Provider Information | |||||||||
| NPI: | 1497792360 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMEN'S PHYSICIAN SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2303 | ||||||||
| Address2: | DEPT. #175 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462062303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178023127 | ||||||||
| FaxNumber: | 3178700499 | ||||||||
| Practice Location | |||||||||
| Address1: | 8081 TOWNSHIP LINE RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462602087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172281100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 03/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | KELLER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3172281100 | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | NEVER ISSUED | 05 | IN | MEDICAID |