1124064530 NPI number — EDWARD P AGUILAR P.A.

Table of content: EDWARD P AGUILAR P.A. (NPI 1124064530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124064530 NPI number — EDWARD P AGUILAR P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGUILAR
Provider First Name:
EDWARD
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
M

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:
1124064530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 485
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46122-0485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-745-6139
Provider Business Mailing Address Fax Number:
317-745-7873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E.MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-745-3450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  10000357A , 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: 970016923 . This is a "RAILROAD RETIREE MEDICARE" identifier . This identifiers is of the category "OTHER".




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