1437315132 NPI number — NORTHERN SURGICAL CONSULTANTS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437315132 NPI number — NORTHERN SURGICAL CONSULTANTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN SURGICAL CONSULTANTS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1437315132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 FAIRGROUNDS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIPTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46072-9596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-675-3872
Provider Business Mailing Address Fax Number:
765-675-8472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 FAIRGROUNDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIPTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46072-9596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-675-3872
Provider Business Practice Location Address Fax Number:
765-675-8472
Provider Enumeration Date:
08/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DELUMPA
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
BYRON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
765-675-3872

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  01044980A , 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: 200105790A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com