GRAND OLE DOCS OF THE SOUTHSIDE, LLC (NPI# 1871693994) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871693994 |
| Entity Type | Organization |
| Organization Name | GRAND OLE DOCS OF THE SOUTHSIDE, LLC |
| Other Organization Name | CENTRAL INDIANA MEDICAL GROUP |
| Practice Address |
365 E Main St Greenwood IN 46143-1361 |
| Mailing Address |
1350 E County Line Rd Suite H Indianapolis IN 46227-0873 |
| Practice Telephone | 3178815152 |
| Practice Fax Number | 3178818993 |
| Mailing Telephone | 3178877725 |
| Mailing Fax Number | 3178877751 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2013-12-05 |
| Authorized Official Name | ROBERT V KLAASEN (MANAGING PHYSICIAN) |
| Authorized Official Telephone | 3178826663 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | DME | 5457630001 | 01 |
| IN | GROUP RR MEDICARE # | CI4722 | 01 |
| Other Name | Type Code |
|---|---|
| Central Indiana Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639359037 | Grand Ole Docs of The Southside, LLC | Family Medicine | 6349 S East St, Indianapolis, IN 46227-7107 | 2007-11-14 |
| 1033205984 | Grand Ole Docs of The Southside, LLC | Family Medicine | 8686 Madison Ave, Suite F, Indianapolis, IN 46227-7207 | 2006-10-05 |
| 1477653509 | Grand Ole Docs of The Southside, LLC | Family Medicine | 365 E Main St, Greenwood, IN 46143-1361 | 2006-09-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | GRAND OLE DOCS OF THE SOUTHSIDE, LLC | 1350 E County Line Rd, Ste H, Indianapolis, IN 46227-0900 |
| Street Address |
365 E MAIN ST |
| City | GREENWOOD |
| State | IN |
| Zip Code | 46143-1361 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043285604 | Charles L Richert | Family Medicine | 365 E Main St, Greenwood, IN 46143-1361 | 2006-02-17 |
| 1477653509 | Grand Ole Docs of The Southside, LLC | Family Medicine | 365 E Main St, Greenwood, IN 46143-1361 | 2006-09-25 |
| 1760457329 | Robert V Klaasen | Family Medicine | 365 E Main St, Greenwood, IN 46143-1361 | 2006-02-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395299 | Tiffany Smirat | Pharmacist | 882 S Sr 135, Greenwood, IN 46143 | 2020-10-27 |
| 1083250138 | Benajmin Thomas Nyboer | Pharmacist | 5961 North State Road 135, Kroger Pharmacy, Greenwood, IN 46143 | 2019-11-25 |
| 1609417260 | Orthopaedics-indianapolis, Inc | Orthopaedic Surgery | 1579 Olive Branch Parke Lane, Suite 130, Greenwood, IN 46143 | 2019-10-04 |
| 1194282525 | Homebased Mental Health Service | Case Management | 2244 Blossom Dr, Greenwood, IN 46143 | 2019-02-21 |
| 1710478078 | Anne E Packard | Pharmacist | 333 E County Line Rd # 101, Greenwood, IN 46143 | 2018-05-22 |
| 1033607924 | Ez Clinic Inc. | Nurse Practitioner | 494 S Emerson Ave Ste I, Greenwood, IN 46143 | 2018-04-25 |
| 1891246633 | Kroger Limited Partnership I | Durable Medical Equipment & Medical Supplies | 5961 N Sr 135, Greenwood, IN 46143 | 2016-10-17 |
| 1477919637 | Ourhealth Physicians Group, LLC | Clinic/Center | 1273 N Emerson Ave Ste H, Greenwood, IN 46143 | 2016-01-04 |
| 1003212655 | American Health Network of Indiana, LLC | Non-Pharmacy Dispensing Site | 2355 Endress Place St A, Healthy Measures Wellness Clinic, Greenwood, IN 46143 | 2014-11-10 |
| 1265831366 | Katie D'agosto | Counselor | 3000 S State Road 135 Ste 230, Greenwood, IN 46143 | 2014-08-14 |
| Find all providers in zip 46143 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245862473 | Kristina Mckissick | Family Medicine | 805 Montague Ave, Greenwood, SC 29649-1471 | 2020-02-05 |
| 1487212130 | Self Medical Group | Family Medicine | 105 Vinecrest Ct # 510, Greenwood, SC 29646-8031 | 2019-05-29 |
| 1750800264 | Self Medical Group | Family Medicine | 110 Highway 246 N, Greenwood, SC 29649-8748 | 2017-09-15 |
| 1689066060 | Richard Glen Huber | Family Medicine | 31 N Restin Rd, Greenwood, IN 46142-8583 | 2015-02-23 |
| 1679912406 | Michael J. Mooney | Family Medicine | 965 Emerson Pkwy Ste J, Greenwood, IN 46143 | 2013-06-14 |
| 1114362639 | Sarah Ann Beeson | Family Medicine | 1000 Us Highway 31 S, Greenwood, IN 46143-2407 | 2013-05-10 |
| 1013350198 | Elise Rose Laroche | Family Medicine | 747 E County Line Rd Ste D, Greenwood, IN 46143-1082 | 2013-04-09 |
| 1548506868 | Community Health Network Inc | Family Medicine | 615 W Smith Valley Rd, Greenwood, IN 46142-3048 | 2012-12-13 |
| 1801158456 | Frank William Fortuna | Family Medicine | 461 Camby Court, Greenwood, IN 46142 | 2012-06-11 |
| 1417252636 | Self Medical Group | Family Medicine | 138 Wells Avenue, Greenwood, SC 29646-3837 | 2011-01-19 |
| Find all providers in GREENWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.