NPIMap

Organization Active NPI

Obsidian Surgical LLC

  • Plastic Surgery Physician
  • Avon, IN
National Provider Identifier
1154857548
Registry record updated May 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
01068593A Issued in IN
Legal business name
OBSIDIAN SURGICAL LLC
Practice address
10090 E US Highway 36
Suite D
Avon, IN 46123-8175
Phone
(317) 399-4567
NPI assigned
May 4, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2017

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

Authorized official

Name
Dr. Stanley Joseph Harper, MD
Title
MD/President/Owner
Phone
(317) 399-4567

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X 01068593A IN Primary

Addresses

Primary practice location

10090 E US Highway 36
Suite D
Avon, IN 46123-8175

Mailing address

1805 Beaufain St
Carmel, IN 46032-7202
Phone (317) 399-4567

Other identifiers 1

IdentifierTypeStateIssuer
01068593AOtherINMEDICAL LICENSE

National Provider Directory

National Provider Directory

Locations

10090 E US Highway 36
Ste D
Avon, IN 46123
Phone (317) 399-4567

NPI Registry JSON

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

{
    "created_epoch": "1493856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493856000000",
    "number": "1154857548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 BEAUFAIN ST",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460327202",
            "telephone_number": "317-399-4567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10090 E US HIGHWAY 36",
            "address_2": "SUITE D",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461238175",
            "telephone_number": "317-399-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSIDIAN SURGICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-04",
        "last_updated": "2017-05-04",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "MD/PRESIDENT/OWNER",
        "authorized_official_telephone_number": "317-399-4567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "IN",
            "license": "01068593A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "01068593A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.