1780767186 NPI number — ANN M BIDDLE PA

Table of content: ANN M BIDDLE PA (NPI 1780767186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780767186 NPI number — ANN M BIDDLE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIDDLE
Provider First Name:
ANN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1780767186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7775985
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-5985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-770-6900
Provider Business Mailing Address Fax Number:
317-770-6911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18051 RIVER RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOBLESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46062-7092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-773-0002
Provider Business Practice Location Address Fax Number:
317-776-6095
Provider Enumeration Date:
10/23/2006

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: 363A00000X , with the licence number:  10000499 , 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: 200900770 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".