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Organization
CCSG LLC
Active
Organization
CCSG LLC
Active
Other names
Clarian Cardiovascular Surgeons
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL L ODLE (PRESIDENT/CEO)
(317) 962-4836
Entity
Organization
Contact information
Practice address
1801 N SENATE BLVD, STE 755, INDIANAPOLIS, IN 46202-1228
(317) 962-5888
(317) 962-6259
Mailing address
250 N SHADELAND AVE, STE 200, INDIANAPOLIS, IN 46219-4959
(317) 962-4836
(317) 962-4996
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
03/18/2008
Last updated
02/16/2010
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