1063464196 NPI number — HEALTHMASTERS,INC.

Table of content: (NPI 1063464196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063464196 NPI number — HEALTHMASTERS,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHMASTERS,INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063464196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 WILLOWCREEK RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTAGE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46368-4486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-762-0004
Provider Business Mailing Address Fax Number:
219-762-0082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 WILLOWCREEK RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46368-4486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-762-0004
Provider Business Practice Location Address Fax Number:
219-762-0082
Provider Enumeration Date:
05/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARMON
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
219-762-0004

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  060063891 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100450580 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200032900 . This is a "MEDICAID WAIVER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".