1023195021 NPI number — CENTER FOR OTOLARYNGOLOGY AND FACIAL PLASTIC SURGERY, L.L.C.

Table of content: FOZIA KAMIL HASSEN LVN (NPI 1437555240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023195021 NPI number — CENTER FOR OTOLARYNGOLOGY AND FACIAL PLASTIC SURGERY, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR OTOLARYNGOLOGY AND FACIAL PLASTIC SURGERY, L.L.C.
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:
1023195021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 958
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHERERVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46375-0958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2203 45TH ST
Provider Second Line Business Practice Location Address:
SUITE 'B'
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46322-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-4820
Provider Business Practice Location Address Fax Number:
219-836-5186
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CATALDI
Authorized Official First Name:
BETHANY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
219-836-4820

Provider Taxonomy Codes

  • Taxonomy code: 207YS0123X , with the licence number:  02002695A , 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: 200841030 A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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