1215964127 NPI number — VIVEK S SAHGAL M.D., FACP

Table of content: VIVEK S SAHGAL M.D., FACP (NPI 1215964127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215964127 NPI number — VIVEK S SAHGAL M.D., FACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAHGAL
Provider First Name:
VIVEK
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., FACP
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:
1215964127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 MICHIGAN AVE
Provider Second Line Business Mailing Address:
SUITE 170
Provider Business Mailing Address City Name:
LOGANSPORT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46947-1580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-722-4331
Provider Business Mailing Address Fax Number:
574-722-6856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 MICHIGAN AVE
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947-1580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-722-4331
Provider Business Practice Location Address Fax Number:
574-722-6856
Provider Enumeration Date:
06/27/2006

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: 207RI0200X , with the licence number:  0426739 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 112358 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 01073427A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 01073427A , 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: 1215964127 . This is a "UNICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 243233 . This is a "COVENTRY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 25244031 . This is a "BCBSKC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00230613 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100290230D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201209650 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209722024 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5188509 . This is a "AETNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 104950 . This is a "MEDICARE LEAVENWORTH INDIVIDUAL" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 104950 . This is a "BCBSKC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: MA1199001 . This is a "MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 121596412 . This is a "MOLINA INDIVIDUAL" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P01283806 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000852931 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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