1689773681 NPI number — GREENWOOD PEDIATRICS PC

Table of content: (NPI 1689773681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689773681 NPI number — GREENWOOD PEDIATRICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENWOOD PEDIATRICS 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:
1689773681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 E COUNTY LINE RD
Provider Second Line Business Mailing Address:
SUITE B2
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46227-2932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-887-6060
Provider Business Mailing Address Fax Number:
317-859-5946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 E COUNTY LINE RD
Provider Second Line Business Practice Location Address:
SUITE B2
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46227-2932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-887-6060
Provider Business Practice Location Address Fax Number:
317-859-5946
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
317-887-6060

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , 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: 100193950A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com