1194960807 NPI number — KEITH M RAMSEY MEDICAL CORP

Table of content: (NPI 1194960807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194960807 NPI number — KEITH M RAMSEY MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEITH M RAMSEY MEDICAL CORP
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:
KEITH M RAMSEY MD
Provider Other Organization Name Type Code:
5
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:
1194960807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1512 BURR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46406-2369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-944-3933
Provider Business Mailing Address Fax Number:
219-944-2473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7863 BROADWAY STE 244
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-5553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-991-3602
Provider Business Practice Location Address Fax Number:
219-962-5058
Provider Enumeration Date:
12/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BLACKMON
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
219-545-3423

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  01036485A , 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: 100201350A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036068254 . This is a "ILLINOIS MEDICAID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0090000637 . This is a "BLUE CROSS/BLUE OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 000000090423 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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