Organization
INDIANA ENDOSCOPY CENTERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT BOEGLIN (PRESIDENT)
(317) 962-5660
Entity
Organization
Contact information
Practice address
10967 ALLISONVILLE RD, SUITE 100, FISHERS, IN 46038-2630
(317) 962-5660
Mailing address
1801 N SENATE BLVD, SUITE 410, INDIANAPOLIS, IN 46202-1228
(317) 962-5660
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
08-006221-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200893990C
—
IN
01
—
ZJ0010
MEDICARE PTAN
—
Enumeration date
07/24/2008
Last updated
01/03/2011
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