Provider Demographics
NPI:1336180173
Name:BELTWAY SURGERY CENTERS LLC
Entity type:Organization
Organization Name:BELTWAY SURGERY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, ASC CLINICAL OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, CNOR
Authorized Official - Phone:317-817-1095
Mailing Address - Street 1:151 PENNSYLVANIA PKWY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1379
Mailing Address - Country:US
Mailing Address - Phone:317-817-1126
Mailing Address - Fax:317-817-1059
Practice Address - Street 1:151 PENNSYLVANIA PKWY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46280-1379
Practice Address - Country:US
Practice Address - Phone:317-817-1126
Practice Address - Fax:317-817-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060022771261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN36858OtherMPLAN
IN414184OtherHEALTHLINK
IN200255810AMedicaid
INC65260OtherC5HC5
IN200255810AOtherHCI
ZJ1000Medicare ID - Type Unspecified