1386958759 NPI number — INDIANA HEALTHCARE PHYSICIAN SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386958759 NPI number — INDIANA HEALTHCARE PHYSICIAN SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA HEALTHCARE PHYSICIAN SERVICES 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:
1386958759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 N 7TH ST
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701-1880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-357-7196
Provider Business Mailing Address Fax Number:
724-357-7279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 N 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-1880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-357-7196
Provider Business Practice Location Address Fax Number:
724-357-7279
Provider Enumeration Date:
07/28/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEDLEMEYER
Authorized Official First Name:
ANN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
724-357-7334

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0017702500010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".