Organization
INDIANA CLINIC CRITICAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH L COLEMAN (CFO)
(317) 948-3525
Entity
Organization
Contact information
Practice address
1801 N SENATE BLVD, STE 230, INDIANAPOLIS, IN 46202-1228
(317) 962-5820
(317) 962-3916
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200984010
—
IN
Enumeration date
12/07/2009
Last updated
09/14/2023
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