NPIMap

Organization Active NPI

Immediadent of Indiana, P.C.

  • Dentist
  • Indianapolis, IN
National Provider Identifier
1063560555
Registry record updated Apr 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
IMMEDIADENT OF INDIANA, P.C.
Practice address
3269 W. 86TH Street
Suite a-2
Indianapolis, IN 46268-3822
Phone
(317) 542-3440
Fax
(913) 800-6967
NPI assigned
Jan 8, 2007
Organization subpart
Yes
Parent organization
IMMEDIADENT OF INDIANA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 12, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amy Wheeler
Title
Credentialing Coordinator
Phone
(913) 800-6952

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X IN Primary

Addresses

Primary practice location

3269 W. 86TH Street
Suite a-2
Indianapolis, IN 46268-3822

Mailing address

PO Box 11568
Overland Park, KS 66207-4268
Phone (913) 428-1674

Other identifiers 1

IdentifierTypeStateIssuer
200377170MedicaidIN

Other names 1

  • ImmediaDent Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Immediadent of Indiana PC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3269 W 86th St
Ste A2
Indianapolis, IN 46268
Phone (317) 542-3440

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491955200000",
    "number": "1063560555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11568",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662074268",
            "telephone_number": "913-428-1674",
            "fax_number": "913-800-6967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3269 W. 86TH STREET",
            "address_2": "SUITE A-2",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462683822",
            "telephone_number": "317-542-3440",
            "fax_number": "913-800-6967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMEDIADENT OF INDIANA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IMMEDIADENT OF INDIANA, P.C.",
        "enumeration_date": "2007-01-08",
        "last_updated": "2017-04-12",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "913-800-6952"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200377170",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ImmediaDent",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.