Basic Information
| Provider Information | |||||||||
| NPI: | 1891935201 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST CAMPUS SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5445 E 16TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462184869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173557000 | ||||||||
| FaxNumber: | 3173512428 | ||||||||
| Practice Location | |||||||||
| Address1: | 5445 E 16TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462184869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173557000 | ||||||||
| FaxNumber: | 3173512428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2009 | ||||||||
| LastUpdateDate: | 02/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | WALTON | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3173557000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 080108171 | IN | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.