1821042375 NPI number — RONNIE RATKAY CRNA

Table of content: RONNIE RATKAY CRNA (NPI 1821042375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821042375 NPI number — RONNIE RATKAY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RATKAY
Provider First Name:
RONNIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1821042375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
541 OTIS BOWEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321-4158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-934-5300
Provider Business Mailing Address Fax Number:
219-934-5389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 W 89TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-6254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-757-5275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2006

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: 163W00000X , with the licence number:  28065161A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 28065161A , 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: 000000273367 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200152290 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00015469 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".