Provider Demographics
NPI:1669559928
Name:SENATE STREET SURGERY CENTER LLC
Entity type:Organization
Organization Name:SENATE STREET SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SENATE STREET SURGERY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-562-5660
Mailing Address - Street 1:1701 N SENATE AVE
Mailing Address - Street 2:SUITE 338
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5306
Mailing Address - Country:US
Mailing Address - Phone:317-962-9303
Mailing Address - Fax:317-962-1095
Practice Address - Street 1:1701 SENATE BLVD
Practice Address - Street 2:SUITE 338
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-9303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200887640AMedicaid
IN200887640AMedicaid