Central Indiana Medical Group

LBN: Grand Old Docs Of The Southside
Central Indiana Medical Group is an health care organization with primary practice located at 360 S Madison Ave #200, Greenwood IN 46142-3150. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Grand Old Docs Of The Southside can be contacted via phone (317) 865-9090, or through Russell, Brenda R via phone (317) 865-9090.

Contact Information

Primary practice address
360 S Madison Ave #200 Greenwood IN 46142-3150
Phone: (317) 865-9090
Fax: (317) 865-0523
Website:
Map and Directions
Authorized official contact:
Name: Russell, Brenda R Doctor of Medicine (MD)
Phone: (317) 865-9090

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1790886844
LBN Legal business name Grand Old Docs Of The Southside
DBA Doing business as Central Indiana Medical Group
Authorized official Russell, Brenda R Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Sep 25th, 2006
Last updated Jun 30th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790886844 NPPES
Indiana Other 5457630003 DME
Indiana Other CI4722 DME

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