Provider Demographics
NPI:1023115243
Name:INDIANA NEUROSCIENCE ASSOCIATES
Entity type:Organization
Organization Name:INDIANA NEUROSCIENCE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRENTIALING DEPT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-570-7900
Mailing Address - Street 1:6330 CASTLEPLACE DR # 130
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1902
Mailing Address - Country:US
Mailing Address - Phone:317-570-7900
Mailing Address - Fax:317-570-2288
Practice Address - Street 1:8333 NAAB RD STE 260
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1983
Practice Address - Country:US
Practice Address - Phone:317-570-7900
Practice Address - Fax:317-570-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1000829A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01000829AOtherSTATE LICENSE