Indianapolis Immunization Group

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

INDIANAPOLIS IMMUNIZATION GROUP

Doing business as

Passport Health Indiana

Practice address

1030 E 86TH St
Suite E
Indianapolis, IN 46240-1866

Phone

(317) 844-2990

Fax

(317) 844-1706

NPI assigned

Apr 26, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Durs

Title

President

Phone

(317) 844-2990

Specialties & licenses 1

Addresses

Other names 1

• Passport Health Indiana Doing business as

Locations

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154541795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 E 86TH ST",
            "address_2": "SUITE E",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401866",
            "telephone_number": "317-844-2990",
            "fax_number": "317-844-1706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 E 86TH ST",
            "address_2": "SUITE E",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401866",
            "telephone_number": "317-844-2990",
            "fax_number": "317-844-1706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANAPOLIS IMMUNIZATION GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DURS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-844-2990",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passport Health Indiana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.