PROVIDENCE MEDICAL ASSOCIATES LLC (NPI# 1326654070) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326654070 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE MEDICAL ASSOCIATES LLC |
| Practice Address |
1935 N Capitol Ave Ste 107 Indianapolis IN 46202-6403 |
| Mailing Address |
4000 W 106th St Ste 125-207 Carmel IN 46032-7720 |
| Practice Telephone | 7166862104 |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-10-22 |
| Authorized Official Name | OLUFUNKE LOUISE BRIMMO-LONGE (OWNER) |
| Authorized Official Telephone | 7166862104 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| Street Address |
1935 N CAPITOL AVE STE 107 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46202-6403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386886 | Sara Brooke Horn | Registered Nurse | 1801 N Senate Ave Ste 3300, Indianapolis, IN 46202 | 2020-11-04 |
| 1013521905 | Zachary Camden Grimes | Registered Nurse | 720 Eskenazi Avenute, Indianapolis, IN 46202 | 2020-09-08 |
| 1790314045 | Scott C Mitchell II | Student in an Organized Health Care Education/Training Program | Indiana University School of Medicine Dept of Neurosurg, 355 W. 16th St, Gh 5100, Indianapolis, IN 46202 | 2020-04-07 |
| 1053940676 | James Patrick Kelly Iv | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr., Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1124657697 | Betsy Wilson Stevens | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Drive, Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1093340580 | Brian T Edmonds | Social Worker | Sandra Eskenazi Mental Health Center, 1700 N Illinois St, Indianapolis, IN 46202 | 2020-03-05 |
| 1326683210 | Lindsay Nicole Rich | Nurse Practitioner | 1800 N Senate Ave, Indianapolis, IN 46202 | 2019-11-14 |
| 1427693670 | Ronald Mcdonald House Charities of Central Indiana | Voluntary or Charitable | 435 Limestone Street, Indianaplois, IN 46202 | 2019-11-12 |
| 1790344760 | Kirsten Denise Leaberry | Student in an Organized Health Care Education/Training Program | Iu Health Neuroscience Center, Goodman Hall, 355 West 16th Street, Indianapolis, IN 46202 | 2019-06-12 |
| 1679138093 | Chris Olson Jr. | Student in an Organized Health Care Education/Training Program | 1701 N. Senate Blvd, Ag012, Indianapolis, IN 46202 | 2019-05-02 |
| Find all providers in zip 46202 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306222757 | Midwest Wellness LLC | Clinic/Center | 6822 E 82nd St Ste 310, Indianapolis, IN 46250-1677 | 2015-08-08 |
| 1861757023 | Integrative Therapeutics LLC | Clinic/Center | 11074 Woods Bay Ln, Indianapolis, IN 46236-9020 | 2012-07-12 |
| 1609079607 | Jeffrey D. Wagner, Md, PC | Clinic/Center | 8040 Clearvista Pkwy Ste 570, Indianapolis, IN 46256-4673 | 2007-06-07 |
| 1457736811 | Ace Medical Services | Clinic/Center | 855 N High School Rd, Suite 5, Indianapolis, IN 46214-5701 | 2015-07-28 |
| 1679916001 | Integrated Medical Care and Nephrology LLC | Clinic/Center | 6925 Shore Ter, Indianapolis, IN 46254-4675 | 2013-04-16 |
| 1043500010 | Franciscan Saint Francis Hospitals and Health Centers | Clinic/Center | 5230 E Stop 11 Rd Ste A, Indianapolis, IN 46237-6339 | 2011-04-12 |
| 1801116223 | Neurological Care of Indiana Inc | Clinic/Center | 3500 Depauw Blvd Ste 2082, Indianapolis, IN 46268-1137 | 2010-06-08 |
| 1881875540 | Indiana Center for Health and Nutrition | Clinic/Center | 7440 N Shadeland Ave, Suite 206, Indianapolis, IN 46250-2029 | 2007-11-21 |
| 1265644397 | Indiana Spine and Pain Center Inc | Clinic/Center | 8202 Clearvista Parkway, Suite 9 E, Indianapolis, IN 46256-1457 | 2007-05-03 |
| 1770706160 | Aba Programming Inc. | Clinic/Center | 7901 E 88th St, Indianapolis, IN 46256-1235 | 2007-04-11 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46202 |
Please comment or provide details below to improve the information on PROVIDENCE MEDICAL ASSOCIATES LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.