PROVIDENCE MEDICAL ASSOCIATES LLC NPI 1326654070

NPI Information

PROVIDENCE MEDICAL ASSOCIATES LLC is a medical specialty clinic center in Indianapolis, IN. The provider is 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). PROVIDENCE MEDICAL ASSOCIATES LLC NPI is 1326654070. The provider is registered as an organization entity type.

The provider's business location address is:

1935 N CAPITOL AVE STE 107
INDIANAPOLIS, IN
ZIP 46202-403
Phone: (716) 686-2104

The provider's authorized official is Olufunke Louise Brimmo-longe .
The authorized official title is Owner and has the following contact phone number (716) 686-2104.

The enumeration date for this NPI number is 9/18/2020 and was last updated on 10/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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