Basic Information
| Provider Information | |||||||||
| NPI: | 1831393248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NAGAN, ARREGUI, & DAVIS, MDS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8402 HARCOURT RD STE 815 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462602057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178721158 | ||||||||
| FaxNumber: | 3178721186 | ||||||||
| Practice Location | |||||||||
| Address1: | 8402 HARCOURT RD | ||||||||
| Address2: | STE 815 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462602074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178721158 | ||||||||
| FaxNumber: | 3178721186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 10/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3178721158 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100065850A | 05 | IN | MEDICAID | CC4597 | 01 | IN | RAILROAD MEDICARE | OTHER |