Provider Demographics
NPI:1023148541
Name:BEECH GROVE URGENT CARE,INC
Entity type:Organization
Organization Name:BEECH GROVE URGENT CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-786-1888
Mailing Address - Street 1:4902 E THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-1905
Mailing Address - Country:US
Mailing Address - Phone:317-786-1888
Mailing Address - Fax:317-786-1889
Practice Address - Street 1:4902 E THOMPSON RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-1905
Practice Address - Country:US
Practice Address - Phone:317-786-1888
Practice Address - Fax:317-786-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042881261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200332730AMedicaid
IN200332730AMedicaid