Provider Demographics
NPI:1306046826
Name:DIAGNOSTIC RHEUMATOLOGY AND RESEARCH PC
Entity type:Organization
Organization Name:DIAGNOSTIC RHEUMATOLOGY AND RESEARCH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-859-6364
Mailing Address - Street 1:1030 E COUNTY LINE RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2932
Mailing Address - Country:US
Mailing Address - Phone:317-859-6364
Mailing Address - Fax:
Practice Address - Street 1:1030 E COUNTY LINE RD
Practice Address - Street 2:SUITE B1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2932
Practice Address - Country:US
Practice Address - Phone:317-859-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026374207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN214850Medicare PIN