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Organization
CORVASC MDS PC
Active
Organization
CORVASC MDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYNNE TROMBLE (ADMINISTRATOR)
(317) 583-7600
Entity
Organization
Contact information
Practice address
8433 HARCOURT ROAD, SUITE 100, INDIANAPOLIS, IN 46260-2193
(317) 583-7600
(317) 583-7601
Mailing address
8433 HARCOURT ROAD, SUITE 300, INDIANAPOLIS, IN 46260-2190
(317) 583-7702
(317) 583-7601
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
50000804A
IN
2085R0204X
Vascular & Interventional Radiology Physician
50000804A
IN
2086S0129X
Vascular Surgery Physician
50000804A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
50000804A
IN
Other
Enumeration date
07/13/2006
Last updated
06/03/2008
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