1487682670 NPI number — CARY M GUSE MD

Table of content: CARY M GUSE MD (NPI 1487682670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487682670 NPI number — CARY M GUSE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUSE
Provider First Name:
CARY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1487682670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 N MARR RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47201-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-376-9353
Provider Business Mailing Address Fax Number:
812-376-3757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4665 N US HIGHWAY 31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47201-8558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-376-9353
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2006

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:  01050949 , 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: 000000342281 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: CH6222 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200493440 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 041808 . This is a "SIHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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