Basic Information
| Provider Information | |||||||||
| NPI: | 1184873739 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDIANA EMERGENCY PHYSICIANS LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CORPORATE BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705083870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008939698 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 23RD ST | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474214704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122753331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2008 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | LIPSMEYER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8008939698 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | IN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000594458 | 01 | IN | BLUE SHIELD | OTHER | 200173120D | 05 | IN | MEDICAID |