1154480440 NPI number — JAMES C GALYEN

Table of content: JAMES C GALYEN (NPI 1154480440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154480440 NPI number — JAMES C GALYEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALYEN
Provider First Name:
JAMES
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1154480440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 S JACKSON PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEYMOUR
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47274-2626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-519-2963
Provider Business Mailing Address Fax Number:
812-519-3515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 S JACKSON PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEYMOUR
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47274-2626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-519-2963
Provider Business Practice Location Address Fax Number:
812-519-3515
Provider Enumeration Date:
12/06/2006

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: 111N00000X , with the licence number:  08001579 , 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: 000000652089 . This is a "ANTHEM-SEYMOUR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 265740B . This is a "MEDICARE-SEYMOUR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200035110 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: N289823 . This is a "HARMONY HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000577041 . This is a "ANTHEM-GREENSBURG" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 219080H . This is a "MEDICARE--GREENSBURG" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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