1871795047 NPI number — DR. MELISSA SUE CAIN M.D.

Table of content: DR. MELISSA SUE CAIN M.D. (NPI 1871795047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871795047 NPI number — DR. MELISSA SUE CAIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAIN
Provider First Name:
MELISSA
Provider Middle Name:
SUE
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:
BUNTON
Provider Other First Name:
MELISSA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871795047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 W JOHNSON RD STE 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PORTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46350-2026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-262-0037
Provider Business Mailing Address Fax Number:
678-487-5329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 W JOHNSON RD STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PORTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46350-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-262-0037
Provider Business Practice Location Address Fax Number:
678-487-5329
Provider Enumeration Date:
06/01/2007

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: 207Q00000X , with the licence number:  01064530A , 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: 200908150 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000610100 . This is a "BCBS MED PT IRELAND RD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000611461 . This is a "BCBS BMG LAPORTE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000001038705 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00752259 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".