Organization
GRAND OLE DOCS OF THE SOUTHSIDE, LLC
Active
Other names
Central Indiana Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW A JOHNSTONE MD (PHYSICIAN)
(317) 884-3725
Entity
Organization
Contact information
Practice address
8686 MADISON AVE, SUITE F, INDIANAPOLIS, IN 46227-7207
(317) 884-3725
(317) 881-0933
Mailing address
1350 E COUNTY LINE RD, SUITE H, INDIANAPOLIS, IN 46227-0873
(317) 887-7725
(317) 887-7751
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5457630002
DME
IN
01
—
CI4722
GROUP RR MEDICARE NUMBER
IN
Enumeration date
10/05/2006
Last updated
12/05/2013
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