1487008934 NPI number — INDIANAPOLIS VAMC

Table of content: TINA ORA JEFFERSON BACHELORS DEGREE (NPI 1932601721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487008934 NPI number — INDIANAPOLIS VAMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANAPOLIS VAMC
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:
1487008934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94483
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44101-4483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-821-7200
Provider Business Mailing Address Fax Number:
608-821-7658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3791 10TH STREET
Provider Second Line Business Practice Location Address:
BUILDING 1010
Provider Business Practice Location Address City Name:
EDINBURGH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46124-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-821-7200
Provider Business Practice Location Address Fax Number:
608-821-7658
Provider Enumeration Date:
04/21/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POTTER
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
NPI TEAM
Authorized Official Telephone Number:
202-382-2579

Provider Taxonomy Codes

  • Taxonomy code: 261QV0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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