Provider Demographics
NPI:1417641606
Name:INTERNATIONAL MEDICAL SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:INTERNATIONAL MEDICAL SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSUE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VILLALTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-489-3265
Mailing Address - Street 1:6925 E 96TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-3654
Mailing Address - Country:US
Mailing Address - Phone:317-489-3265
Mailing Address - Fax:317-489-3714
Practice Address - Street 1:6925 E 96TH ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3654
Practice Address - Country:US
Practice Address - Phone:317-489-3265
Practice Address - Fax:317-489-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty