1538110119 NPI number — DR. MILUS RALPH SKIDMORE M.D.

Table of content: DR. MILUS RALPH SKIDMORE M.D. (NPI 1538110119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538110119 NPI number — DR. MILUS RALPH SKIDMORE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKIDMORE
Provider First Name:
MILUS
Provider Middle Name:
RALPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1538110119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 E VINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTPELIER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47359-1473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-728-8246
Provider Business Mailing Address Fax Number:
765-728-8564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTPELIER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47359-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-728-2421
Provider Business Practice Location Address Fax Number:
765-728-8564
Provider Enumeration Date:
05/16/2006

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: 207Q00000X , with the licence number:  01042381 , 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)