1841524030 NPI number — VA NORTHERN INDIANA HEALTH CARE SYSTEM

Table of content: (NPI 1841524030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841524030 NPI number — VA NORTHERN INDIANA HEALTH CARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VA NORTHERN INDIANA HEALTH CARE SYSTEM
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:
1841524030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 E 38TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46953-4568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-674-3321
Provider Business Mailing Address Fax Number:
765-677-5151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 E 38TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46953-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-674-3321
Provider Business Practice Location Address Fax Number:
765-677-5151
Provider Enumeration Date:
09/22/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAJOR
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
SUICIDE PREVENTION COORDINATOR
Authorized Official Telephone Number:
765-674-3321

Provider Taxonomy Codes

  • Taxonomy code: 2865M2000X , with the licence number:  3400050A , 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)