1659690550 NPI number — DR. LENA JO BUCKWALTER M.D.

Table of content: DR. LENA JO BUCKWALTER M.D. (NPI 1659690550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659690550 NPI number — DR. LENA JO BUCKWALTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKWALTER
Provider First Name:
LENA
Provider Middle Name:
JO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRANKLIN
Provider Other First Name:
LENA
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659690550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8820 S MERIDIAN ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46217-6058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-865-6750
Provider Business Mailing Address Fax Number:
317-865-6759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8820 S MERIDIAN ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46217-6058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-865-6750
Provider Business Practice Location Address Fax Number:
317-865-6759
Provider Enumeration Date:
05/18/2010

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:  01073040A , 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: 201124770 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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