| Indianapolis Perioperative Medicine, Llc | |
|
13000 E 136th St Suite 1100 Fishers IN 46037-9478 | |
| (317) 678-3585 | |
| (317) 863-5084 |
| Full Name | Indianapolis Perioperative Medicine, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 13000 E 136th St, Fishers, Indiana |
| Authorized Official Name and Position | Peter Caccavallo (OWNER) |
| Authorized Official Contact | 3176783585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indianapolis Perioperative Medicine, Llc 13000 E 136th St Suite 1100 Fishers IN 46037-9478 Ph: (317) 678-3585 | Indianapolis Perioperative Medicine, Llc 13000 E 136th St Suite 1100 Fishers IN 46037-9478 Ph: (317) 678-3585 |
| NPI Number | 1720285976 |
|---|---|
| Provider Enumeration Date | 06/29/2007 |
| Last Update Date | 07/15/2014 |
| Medicare PECOS PAC ID | 7618914706 |
|---|---|
| Medicare Enrollment ID | O20050411000597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720285976 | NPI | - | NPPES |
| 200424870-A | Medicaid | IN | |
| DE0272 | Other | IN | RR MEDICARE GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 1053181A (Indiana) | Primary |
| Provider Name | Peter P Caccavallo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205987252 PECOS PAC ID: 0143267237 Enrollment ID: I20100819000226 |
| Provider Name | Abigail Williamson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124534367 PECOS PAC ID: 6709147226 Enrollment ID: I20180226001592 |
| Provider Name | Elizabeth Mary Kent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174240592 PECOS PAC ID: 8022485911 Enrollment ID: I20221107000450 |
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