Provider Demographics
NPI:1912132085
Name:KENDRICK REGIONAL CENTER FOR COLON AND RECTAL CARE
Entity type:Organization
Organization Name:KENDRICK REGIONAL CENTER FOR COLON AND RECTAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FELLOWSHIP COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-834-9618
Mailing Address - Street 1:1215 HADLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-2905
Mailing Address - Country:US
Mailing Address - Phone:317-834-9618
Mailing Address - Fax:317-831-9467
Practice Address - Street 1:1215 HADLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-2905
Practice Address - Country:US
Practice Address - Phone:317-834-9618
Practice Address - Fax:317-831-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066495A208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty