1861450280 NPI number — DR. ELISABETH C VON BUN M.D.

Table of content: DR. ELISABETH C VON BUN M.D. (NPI 1861450280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861450280 NPI number — DR. ELISABETH C VON BUN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VON BUN
Provider First Name:
ELISABETH
Provider Middle Name:
C
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:
1861450280
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 E BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-629-2500
Provider Business Mailing Address Fax Number:
502-629-3166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 GORDON GUTMANN BLVD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-3764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-288-9969
Provider Business Practice Location Address Fax Number:
812-288-9657
Provider Enumeration Date:
05/03/2006

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: 207RH0003X , with the licence number:  32167 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6698103 . This is a "CIGNA PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200085120 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5158197 . This is a "AETNA PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000054971B . This is a "HUMANA PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50007896 . This is a "PASSPORT PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00421372 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000365365 . This is a "ANTHEM PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64360589 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00199433 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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