Organization
ST. MARY ADULT MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DINA M MOURICE NP (NP)
(317) 293-9039
Entity
Organization
Contact information
Practice address
4803 W 71ST ST, INDIANAPOLIS, IN 46268-2149
(317) 293-9039
(855) 538-6177
Mailing address
4803 W 71ST ST, INDIANAPOLIS, IN 46268-2149
(317) 293-9039
(855) 538-6177
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201378550
—
IN
Enumeration date
11/19/2007
Last updated
08/15/2026
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