Grand Ole Docs Of The Southside, Llc in Indianapolis - Family Medicine
Grand Ole Docs Of The Southside, Llc - NPI 1639359037
Grand Ole Docs Of The Southside, Llc is a Family Medicine in Indianapolis, Indiana. Grand Ole Docs Of The Southside, Llc practices all healthcare services and medical treatments related to Family Medicine. The NPI Number for Grand Ole Docs Of The Southside, Llc is 1639359037. The last update date is 2013-12-05.
Grand Ole Docs Of The Southside, Llc's current location address is 1350 E County Line Rd, Indianapolis, Indiana. You can contact this provider via phone number 3178877725 and fax number 3178877751. The mailing address for Grand Ole Docs Of The Southside, Llc is 1350 E County Line Rd, Indianapolis, Indiana. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Grand Ole Docs Of The Southside, Llc |
|---|---|
| Address | 1350 E County Line Rd, Indianapolis, Indiana |
| Phone Number | 3178877725 |
| Fax Number | 3178877751 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | OWNER |
|---|---|
| Authorized Official Name | Dewester N Jeffrey |
| Credentials | MD |
| Telephone Number | 3178070247 |
NPI Number Detail
| NPI Number | 1639359037 |
|---|---|
| Provider Enumeration Date | 2007-11-14 |
| Last Updated Date | 2013-12-05 |
Provider Mailing Address Detail
| Address | 1350 E County Line Rd |
|---|---|
| City | Indianapolis |
| State | Indiana (IN) |
| Post Code | 462270873 |
| Phone Number | 3178877725 |
| Fax Number | 3178877751 |
Provider's Primary Taxonomy Detail
| Speciality | Family Medicine |
|---|---|
| Taxonomy | 207Q00000X |
| Licence No | 01036126A |
|
Definition: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine i |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| CI4722 | IN | GROUP RR MEDICARE # | |
| 5457630005 | IN | DME |
Post Comment/ Review Below
What is the Grand Ole Docs Of The Southside, Llc's unique identification number?
The Grand Ole Docs Of The Southside, Llc has been assigned the NPI (National Provider Identifier) Number 1639359037 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Could you kindly provide the complete physical address where Grand Ole Docs Of The Southside, Llc's facilities are geographically located?
The facilities of Grand Ole Docs Of The Southside, Llc are physically situated at the following location: 1350 E County Line Rd, Indianapolis, IN, 462270873.
What is Grand Ole Docs Of The Southside, Llc's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Grand Ole Docs Of The Southside, Llc's specialized field of practice is Family Medicine, and the corresponding taxonomy code that categorizes this area of specialization is 207Q00000X.
When was the Grand Ole Docs Of The Southside, Llc's 1639359037 issued?
The Grand Ole Docs Of The Southside, Llc's 1639359037 was issued on 2007-11-14.
As of what date were the details related to Grand Ole Docs Of The Southside, Llc most recently updated or revised?
The information pertaining to Grand Ole Docs Of The Southside, Llc, including its address, specialty, and other relevant details, was last updated or revised on 2013-12-05.
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