1255319539 NPI number — MRS. CATHERINE MARY YOCUM PT

Table of content: MRS. CATHERINE MARY YOCUM PT (NPI 1255319539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255319539 NPI number — MRS. CATHERINE MARY YOCUM PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOCUM
Provider First Name:
CATHERINE
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PROSEN
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255319539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 REMINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-296-2223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3218 DAUGHERTY DR
Provider Second Line Business Practice Location Address:
SUITE #160
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47909-3997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-390-5575
Provider Business Practice Location Address Fax Number:
317-486-2189
Provider Enumeration Date:
01/06/2006

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: 225100000X , with the licence number:  05001778A , 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: 200113890B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 650024769 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 11356 . This is a "ARNETT HEALTH PLANS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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