Indiana Spine and Pain Center Inc

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

01040487A Issued in IN

Legal business name

INDIANA SPINE AND PAIN CENTER INC

Practice address

8202 Clearvista Parkway
Suite 9 E
Indianapolis, IN 46256-1457

Phone

(317) 577-1800

Fax

(317) 577-1805

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Phillip R. Kingma, M.D.

Title

Owner/Physician

Phone

(317) 577-1800

Specialties & licenses 2

Addresses

Other names 1

• Indiana Laser Spine Center Inc Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Clayton Kleckner, MD

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1992806194
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360281600000",
    "number": "1265644397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8202 CLEARVISTA PARKWAY",
            "address_2": "SUITE 9 E",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561457",
            "telephone_number": "317-577-1800",
            "fax_number": "317-577-1805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8202 CLEARVISTA PARKWAY",
            "address_2": "SUITE 9 E",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561457",
            "telephone_number": "317-577-1800",
            "fax_number": "317-577-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA SPINE AND PAIN CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2013-02-08",
        "status": "A",
        "authorized_official_last_name": "KINGMA",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "317-577-1800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IN",
            "license": "01040487",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IN",
            "license": "01040487A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana Laser Spine Center Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Indiana Radiology Partners, Inc
• Indiana Re-Entry Integrated Services
• Indiana Regenerative Medicine Institute LLC
• Indiana Regional Foot & Ankle Center PC
• Indiana School for the Deaf
• Indiana Spine Care, LLC
• Indiana Spine Group, PC
• Indiana State Department of Health
• Indiana STS Services Inc
• Indiana Support Services Group LLC

• Medical Specialty Clinic/Center in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Medical Specialty Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2013; 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.