Provider Demographics
NPI:1063852135
Name:KENT B REMLEY MD LLC
Entity type:Organization
Organization Name:KENT B REMLEY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:B
Authorized Official - Last Name:REMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-441-8687
Mailing Address - Street 1:12289 HANCOCK ST
Mailing Address - Street 2:SUITE 34
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5801
Mailing Address - Country:US
Mailing Address - Phone:317-815-8950
Mailing Address - Fax:317-815-8951
Practice Address - Street 1:12289 HANCOCK ST
Practice Address - Street 2:SUITE 34
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5801
Practice Address - Country:US
Practice Address - Phone:317-815-8950
Practice Address - Fax:317-815-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1475001Medicare PIN