Provider Demographics
NPI:1215270384
Name:AMEDCO INDIANA LLC
Entity type:Organization
Organization Name:AMEDCO INDIANA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-881-0022
Mailing Address - Street 1:8076 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7930
Mailing Address - Country:US
Mailing Address - Phone:877-881-0022
Mailing Address - Fax:702-543-0314
Practice Address - Street 1:4648 S SCATTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-2900
Practice Address - Country:US
Practice Address - Phone:765-644-0506
Practice Address - Fax:765-622-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty