1215908538 NPI number — TAMMY MICHELLE CRACE BROWNING PA-C

Table of content: TAMMY MICHELLE CRACE BROWNING PA-C (NPI 1215908538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215908538 NPI number — TAMMY MICHELLE CRACE BROWNING PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWNING
Provider First Name:
TAMMY
Provider Middle Name:
MICHELLE CRACE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRACE
Provider Other First Name:
TAMMY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215908538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5256 E 65TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46220-4819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-429-0120
Provider Business Mailing Address Fax Number:
317-800-7730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5256 E 65TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46220-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-429-0120
Provider Business Practice Location Address Fax Number:
866-202-5499
Provider Enumeration Date:
01/27/2006

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: 363AM0700X , with the licence number:  PA483 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 10001016A , 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: 000000581231 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1208007 . This is a "MEDICARE INDIVIDUAL PROVI" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00655066 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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