Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Grand Old Docs of the Southside

Organization Family Medicine Physician · NPI 1790886844

Grand Old Docs of the Southside is a Family Medicine Physician in Greenwood, Indiana. Registered with an NPI since 2006.

In the registry since
2006

Practice location Address checks out

360 S Madison Ave #200
Greenwood, IN 46142-3150
Phone: (317) 865-9090
Fax: (317) 865-0523
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1790886844
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Brenda Russell — Physician · (317) 865-9090
Other names Central Indiana Medical Group
NPI enumeratedSeptember 25, 2006
Last updated in NPPESJune 30, 2008
Mailing address1350 E County Line Rd, Suite I, Indianapolis, IN 46227-0873

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