1346222429 NPI number — CHARLES T WEBSTER MD

Table of content: CHARLES T WEBSTER MD (NPI 1346222429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346222429 NPI number — CHARLES T WEBSTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBSTER
Provider First Name:
CHARLES
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1346222429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1788 BEBB PARK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKEANA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45053-9321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-295-5797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 MITCHELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47006-8909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-212-0692
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2005

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: 207R00000X , with the licence number:  51999 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 01061131A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 51999 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 01061131A , 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: 200328960 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2197733 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000291736 . This is a "BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00243873 . This is a "RR MCR" identifier . This identifiers is of the category "OTHER".