Basic Information
| Provider Information | |||||||||
| NPI: | 1770983199 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INDIANA HEALTH SOLUTIONS II LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DOCTORS EXPRESS PENDLETON PIKE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2809 TOWNE DR | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460329751 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10950 PENDLETON PIKE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462362843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178267425 | ||||||||
| FaxNumber: | 3178260744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2014 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STANTON | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3177300525 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.