Basic Information
| Provider Information | |||||||||
| NPI: | 1992870885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCORD | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | ELLIOTT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6418 LANDBOROUGH SOUTH DR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462204357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178451305 | ||||||||
| FaxNumber: | 3178423621 | ||||||||
| Practice Location | |||||||||
| Address1: | 7301 N SHADELAND AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178451305 | ||||||||
| FaxNumber: | 3178423641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 09/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 01021201 | IN | N | Other Service Providers | Specialist | 207W00000X | 01021201 | IN | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 000000090298 | 01 | IN | ANTHEM BLUE NETWORK | OTHER | 351924614002 | 01 | IN | ANTHEM BCBS | OTHER |