Provider Demographics
NPI:1730663923
Name:MAOAC, LLC
Entity type:Organization
Organization Name:MAOAC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-213-6762
Mailing Address - Street 1:8856 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2911
Mailing Address - Country:US
Mailing Address - Phone:317-516-1177
Mailing Address - Fax:317-516-5128
Practice Address - Street 1:8856 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2911
Practice Address - Country:US
Practice Address - Phone:317-516-1177
Practice Address - Fax:317-516-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1427027283Medicaid
IN1821290743Medicaid
IN1760892749Medicaid
IN1891162764Medicaid