1407859051 NPI number — DR. DANIEL C EBY D.O.

Table of content: DR. DANIEL C EBY D.O. (NPI 1407859051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407859051 NPI number — DR. DANIEL C EBY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBY
Provider First Name:
DANIEL
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1407859051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 W. 13TH ST.
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47546-1883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-482-7441
Provider Business Mailing Address Fax Number:
812-482-7444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 W. 13TH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47546-1883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-482-7441
Provider Business Practice Location Address Fax Number:
812-482-7444
Provider Enumeration Date:
05/27/2005

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: 207XX0005X , with the licence number:  02001643A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 02001643 , 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: 000000332839 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200042870 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5160900001 . This is a "MEDICARE DME" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200042870A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200021790 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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