1023002250 NPI number — ADRIAN L CARTER D.O.

Table of content: ADRIAN L CARTER D.O. (NPI 1023002250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023002250 NPI number — ADRIAN L CARTER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
ADRIAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1023002250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47706-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-753-3942
Provider Business Mailing Address Fax Number:
812-768-6283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 E OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT BRANCH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47648-1666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-753-3942
Provider Business Practice Location Address Fax Number:
812-768-6283
Provider Enumeration Date:
09/02/2005

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:  02002691A , 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: 000000381087 . This is a "BCBS PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000359663 . This is a "BCBS PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000369566 . This is a "BCBS - URGENT CARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 64076037 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00134516 . This is a "RR MCARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200470110 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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