1457387060 NPI number — HOOSIER CARE III, INC.

Table of content: (NPI 1457387060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457387060 NPI number — HOOSIER CARE III, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOOSIER CARE III, INC.
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:
6
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:
1457387060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 SYCAMORE CT
Provider Second Line Business Mailing Address:
SUITE 113
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47203-1545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-378-9027
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 SYCAMORE CT
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47203-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-378-9027
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLEVINS
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
812-378-9027

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1031 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11100 . This is a "ELDER HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000321812 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0117439 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: PN5 . This is a "CAREFIRST IND/PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 021I . This is a "CAREFIRST - PROV/INQ#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004639000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000321711 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004639000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PN5 . This is a "CAREFIRST - BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 245082 . This is a "UNITED MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71-01244 . This is a "UNITED - EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 155031 . This is a "BC/BS OF DELAWARE" identifier . This identifiers is of the category "OTHER".




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