| NPI | 1669816799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT EDWARD MIMMS Surgeon 317-679-1757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: IN 01068514A) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2013-04-19 |