Provider Demographics
NPI:1528473345
Name:OBJECTIVE SURGICAL LLC
Entity type:Organization
Organization Name:OBJECTIVE SURGICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:800-639-5191
Mailing Address - Street 1:8330 NAAB RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5925
Mailing Address - Country:US
Mailing Address - Phone:800-639-5191
Mailing Address - Fax:855-809-9989
Practice Address - Street 1:8330 NAAB RD
Practice Address - Street 2:SUITE 140
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5925
Practice Address - Country:US
Practice Address - Phone:800-639-5191
Practice Address - Fax:855-809-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty