Provider Demographics
NPI:1427145010
Name:NEUROLOGY INDIANA LLC
Entity type:Organization
Organization Name:NEUROLOGY INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-863-2095
Mailing Address - Street 1:7321 SHADELAND STATION
Mailing Address - Street 2:SUITE 275
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256
Mailing Address - Country:US
Mailing Address - Phone:317-863-2095
Mailing Address - Fax:317-863-2108
Practice Address - Street 1:7321 SHADELAND STATION
Practice Address - Street 2:SUITE 275
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256
Practice Address - Country:US
Practice Address - Phone:317-863-2095
Practice Address - Fax:317-863-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN234220Medicare PIN