Provider Demographics
NPI:1992750756
Name:PARAMOUNT OF INDIANAPOLIS, LLC
Entity type:Organization
Organization Name:PARAMOUNT OF INDIANAPOLIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:520-254-4949
Mailing Address - Street 1:350 EVERGREEN RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1010
Mailing Address - Country:US
Mailing Address - Phone:502-254-4949
Mailing Address - Fax:
Practice Address - Street 1:8530 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1927
Practice Address - Country:US
Practice Address - Phone:317-876-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000195-1314000000X
IN100267690B332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100267690BMedicaid
IN15-5298Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IN100267690BMedicaid