Uaa Indae LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

UAA INDAE LLC

Practice address

4715 Statesmen Dr Ste a
Indianapolis, IN 46250-1997

Phone

(317) 643-5865

Fax

(317) 436-7212

NPI assigned

Jul 15, 2020

Last updated

Jul 15, 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

Jeremy Buckner, DC

Title

Sole Owner

Phone

(480) 930-4018

Specialties & licenses 1

Addresses

Other names 1

• INDAE LLC Other name

Locations

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

{
    "created_epoch": "1594771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594771200000",
    "number": "1689282741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11180",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852840020",
            "telephone_number": "480-930-4018",
            "fax_number": "480-930-4018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4715 STATESMEN DR STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501997",
            "telephone_number": "317-643-5865",
            "fax_number": "317-436-7212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UAA INDAE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-15",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A",
        "authorized_official_last_name": "BUCKNER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "480-930-4018",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INDAE LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.