1396230140 NPI number — EMERI C KINNAMON NP

Table of content: EMERI C KINNAMON NP (NPI 1396230140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396230140 NPI number — EMERI C KINNAMON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINNAMON
Provider First Name:
EMERI
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAIVALKOSKI
Provider Other First Name:
EMERI
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396230140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 ESKENAZI AVE
Provider Second Line Business Mailing Address:
FIFTH THIRD BANK BLDG, 5TH FL
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-5166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-880-4121
Provider Business Mailing Address Fax Number:
317-880-0343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ESKENAZI HEALTH WEST 38TH STREET
Provider Second Line Business Practice Location Address:
5515 38TH ST
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-880-3838
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2018

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: 163W00000X , with the licence number:  28216134A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 71008224A , 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)