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Organization

AMBULATORY SURGERY CENTER AT INDIANA EYE CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANDREA HAUSZ (PRACTICE MANAGER)
(317) 881-3937
Entity
Organization

Contact information

Practice address
30 N EMERSON AVE, GREENWOOD, IN 46143-8895
(317) 881-3937
(317) 887-4012
Mailing address
30 N EMERSON AVE, GREENWOOD, IN 46143-8895
(317) 881-3937
(317) 887-4009

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
05-005394-2
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000217839
BCBS
IN
05
100274240A
IN
01
490005398
RAILROAD MEDICARE
IN
Enumeration date
08/29/2005
Last updated
08/17/2018
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