1437216637 NPI number — DR. JINGER ATTEBERRY-BENNETT PH.D., HSPP

Table of content: DR. JINGER ATTEBERRY-BENNETT PH.D., HSPP (NPI 1437216637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437216637 NPI number — DR. JINGER ATTEBERRY-BENNETT PH.D., HSPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATTEBERRY-BENNETT
Provider First Name:
JINGER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., HSPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ATTEBERRY
Provider Other First Name:
JINGER
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D. HSPP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437216637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10291 N MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46290-1076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-582-1203
Provider Business Mailing Address Fax Number:
317-853-1314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10293 N MERIDIAN ST
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46290-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-582-1203
Provider Business Practice Location Address Fax Number:
317-853-1314
Provider Enumeration Date:
01/03/2007

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: 103TC0700X , with the licence number:  20040292A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 20040292A , 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: 100120710A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 063867 . This is a "VALUE OPTIONS I.D. NO." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000182361 . This is a "ANTHEM PROVIDER I.D. NO." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000182359 . This is a "ANTHEM PROVIDER I.D. NO." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 10022395 . This is a "ENCORE PPO ONE I.D." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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