1487852943 NPI number — THOMAS J. MELHAM, MD, LLC

Table of content: DR. LARRY E BROWN M.D. (NPI 1275593378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487852943 NPI number — THOMAS J. MELHAM, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS J. MELHAM, MD, LLC
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:
1487852943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2810 W ETHEL AVE STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47304-4402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-287-8596
Provider Business Mailing Address Fax Number:
765-287-8593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2810 W ETHEL AVE STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47304-4402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-287-8596
Provider Business Practice Location Address Fax Number:
765-287-8593
Provider Enumeration Date:
07/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MELHAM
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
765-287-8596

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  01039790A , 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: 10784368 . This is a "CAQH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000337600 . This is a "BLUE CROSS ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1851495394 . This is a "NPI PROVIDER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 5646042 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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