Provider Demographics
NPI:1669427480
Name:SMM,LLC
Entity type:Organization
Organization Name:SMM,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHSNER
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS OFFICE
Authorized Official - Phone:317-781-3604
Mailing Address - Street 1:8402 HARCOURT RD
Mailing Address - Street 2:STE 402
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2074
Mailing Address - Country:US
Mailing Address - Phone:317-338-9450
Mailing Address - Fax:317-338-9567
Practice Address - Street 1:8402 HARCOURT RD
Practice Address - Street 2:STE 402
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2074
Practice Address - Country:US
Practice Address - Phone:317-338-9450
Practice Address - Fax:317-338-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherANTHEM
IN200160Medicare ID - Type Unspecified