1407858079 NPI number — DR. LORRAINE WEAN MD

Table of content: DR. LORRAINE WEAN MD (NPI 1407858079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407858079 NPI number — DR. LORRAINE WEAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEAN
Provider First Name:
LORRAINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1407858079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46140-0129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-468-6270
Provider Business Mailing Address Fax Number:
317-468-6268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 E BOYD AVE STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46140-2845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-467-4500
Provider Business Practice Location Address Fax Number:
317-477-6321
Provider Enumeration Date:
08/12/2005

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: 208000000X , with the licence number:  01038518A , 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: 100127970 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000112574 . This is a "ANTHEM PIN #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200311740 E . This is a "MEDICAID GROUP #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 370018015 . This is a "MEDICARE RAILROAD #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 4345468 . This is a "AETNA PIN #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com