Provider Demographics
NPI:1528666922
Name:CARECONNECTMD MEDICAL GROUP INDIANA PC
Entity type:Organization
Organization Name:CARECONNECTMD MEDICAL GROUP INDIANA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:714-552-4123
Mailing Address - Street 1:16162 BEACH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3828
Mailing Address - Country:US
Mailing Address - Phone:888-789-9585
Mailing Address - Fax:
Practice Address - Street 1:9465 COUNSELORS ROW STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3817
Practice Address - Country:US
Practice Address - Phone:657-202-5944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health