Organization
INDIANA SPINE AND PAIN CENTER INC
Active
Other names
Indiana Laser Spine Center Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP R. KINGMA M.D. (OWNER/PHYSICIAN)
(317) 577-1800
Entity
Organization
Contact information
Practice address
8202 CLEARVISTA PARKWAY, SUITE 9 E, INDIANAPOLIS, IN 46256-1457
(317) 577-1800
(317) 577-1805
Mailing address
8202 CLEARVISTA PARKWAY, SUITE 9 E, INDIANAPOLIS, IN 46256-1457
(317) 577-1800
(317) 577-1805
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
01040487
IN
261QM2500X
Medical Specialty Clinic/Center
Primary
01040487A
IN
Other
Enumeration date
05/03/2007
Last updated
02/08/2013
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