1417031907 NPI number — DEL PILAR MEDICAL & URGENT CARE PC

Table of content: (NPI 1417031907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417031907 NPI number — DEL PILAR MEDICAL & URGENT CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEL PILAR MEDICAL & URGENT CARE PC
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:
1417031907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 E DAY RD STE 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISHAWAKA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46545-3452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-271-0268
Provider Business Mailing Address Fax Number:
574-271-0395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 E DAY RD STE 280
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46545-3452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-271-0268
Provider Business Practice Location Address Fax Number:
574-271-0395
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SLUSSER
Authorized Official First Name:
CANDACE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
574-271-0268

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  02001173 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X , with the licence number: 02001173A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 02001173 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200332960 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100092300 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000104315 . This is a "ANTHEM BCBS GROUP NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000104315 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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