| Supro Direct | |
|
701 E County Line Rd Suite 210 Greenwood IN 46143-1072 | |
| (317) 300-7424 | |
| (317) 360-7976 |
| Full Name | Supro Direct |
|---|---|
| Speciality | Family Medicine |
| Location | 701 E County Line Rd, Greenwood, Indiana |
| Authorized Official Name and Position | Praveen Rajanahalli (TIN OWNER) |
| Authorized Official Contact | 3173007424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supro Direct 701 E County Line Rd Suite 210 Greenwood IN 46143-1072 Ph: (317) 300-7424 | Supro Direct 701 E County Line Rd Suite 210 Greenwood IN 46143-1072 Ph: (317) 300-7424 |
| NPI Number | 1750829230 |
|---|---|
| Provider Enumeration Date | 02/06/2017 |
| Last Update Date | 10/09/2023 |
| Medicare PECOS PAC ID | 8921383605 |
|---|---|
| Medicare Enrollment ID | O20170320001957 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750829230 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Praveen Rajanahalli |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1497925572 PECOS PAC ID: 2365636669 Enrollment ID: I20101101000480 |
Community Health Network Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2943 S Morgantown Rd, Greenwood, IN 46143 Phone: 317-882-1233 | |
Meridian Health Services Corp. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1703 W Stones Crossing Rd Ste 330, Greenwood, IN 46143 Phone: 765-288-1928 | |
County Line Medical Pavilion Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 E County Line Rd, Suite B, Greenwood, IN 46143 Phone: 317-497-6333 Fax: 317-497-6334 | |
Greenwood Group Health, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 549 E County Line Rd Ste D, Greenwood, IN 46143 Phone: 281-429-8526 | |
Premier Family Medicine, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 747 E County Line Rd Ste B, Greenwood, IN 46143 Phone: 317-789-9600 Fax: 317-789-0600 | |
Greenwood Family Care A.s.a.p. Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1680 Stonegate Dr, Greenwood, IN 46142 Phone: 317-215-4367 Fax: 317-888-4706 | |
Southside Adult Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 45 N Madison Ave, Greenwood, IN 46142 Phone: 317-887-7624 Fax: 317-887-7625 |