# 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:** 1639359037
- **Authorized official:** JEFFREY N DEWESTER MD (OWNER)
- **Authorized official phone:** (317) 807-0247

## Contact information

- **Practice address:** 6349 S EAST ST, INDIANAPOLIS, IN 46227-7107
- **Practice address phone:** (317) 807-0247
- **Practice address fax:** (317) 735-1951
- **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 | 01036126A | IN | Yes |

## Other

- **Enumeration date:** 11/14/2007
- **Last updated:** 12/05/2013