# SQUAREONE WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497273494
- **Authorized official:** NORMAN WILLIAMS (PRESIDENT/CEO)
- **Authorized official phone:** (317) 698-7274

## Contact information

- **Practice address:** 5422 N KEYSTONE AVE, INDIANAPOLIS, IN 46220
- **Practice address phone:** (317) 698-7274
- **Mailing address:** 5422 N KEYSTONE AVE, INDIANAPOLIS, IN 46220-3456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/30/2017
- **Last updated:** 08/24/2018