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Organization

ADVANCED SURGERY OF INDIANA LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SCOTT EDWARD MIMMS M.D. (SURGEON)
(317) 679-1757
Entity
Organization

Contact information

Practice address
9470 BRIDGEWATER CIR, INDIANAPOLIS, IN 46250-3412
(317) 598-0094
Mailing address
PO BOX 56051, INDIANAPOLIS, IN 46256-0051
(317) 598-0094

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
01068514A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200986830
IN
Enumeration date
04/19/2013
Last updated
04/19/2013
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