# GRAND OLE DOCS OF THE SOUTHSIDE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Central Indiana Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033205984
- **Authorized official:** ANDREW A JOHNSTONE MD (PHYSICIAN)
- **Authorized official phone:** (317) 884-3725

## Contact information

- **Practice address:** 8686 MADISON AVE, SUITE F, INDIANAPOLIS, IN 46227-7207
- **Practice address phone:** (317) 884-3725
- **Practice address fax:** (317) 881-0933
- **Mailing address:** 1350 E COUNTY LINE RD, SUITE H, INDIANAPOLIS, IN 46227-0873
- **Mailing address phone:** (317) 887-7725
- **Mailing address fax:** (317) 887-7751

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 12/05/2013