Providence Medical Associates LLC
NPI #1326654070 in Indianapolis, Indiana
Provider Information
- NPI Number
- 1326654070
- Entity Type
- Organization
- Organization Name
- Providence Medical Associates LLC
- Primary Specialty
- Clinic/Center - Medical Specialty
- Enumeration Date
- Sep 18, 2020
- Last Updated
- Oct 22, 2020
Practice Location
- Address
- 1935 N CAPITOL AVE STE 107
- City
- Indianapolis
- State
- Indiana
- ZIP Code
- 46202-6403
- Phone
- (716) 686-2104
Authorized Official
- Name
- OLUFUNKE LOUISE BRIMMO-LONGE
- Title
- OWNER
- Phone
- (716) 686-2104
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Medical Specialty — Medical Specialty |
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