1841261666 NPI number — DR. BETH A WHITTINGTON M.D.

Table of content: DR. BETH A WHITTINGTON M.D. (NPI 1841261666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841261666 NPI number — DR. BETH A WHITTINGTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITTINGTON
Provider First Name:
BETH
Provider Middle Name:
A
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:
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:
1841261666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1185 W CARMEL DR
Provider Second Line Business Mailing Address:
D-3
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-8706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-249-0990
Provider Business Mailing Address Fax Number:
317-249-0999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1185 W CARMEL DR
Provider Second Line Business Practice Location Address:
D-3
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-8706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-249-0990
Provider Business Practice Location Address Fax Number:
317-249-0999
Provider Enumeration Date:
01/30/2006

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: 2084N0400X , with the licence number:  01058120 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 01058120A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00164333 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 129480500 . This is a "DEPT OF LABOR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 7910590 . This is a "AETNA REFERRAL NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000339847 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200491200A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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